{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JACQUELINE   C DRUMHELLER","gend":1,"add":"7992 DIGGS RD APT C","city":"NORFOLK","state":"VA","zip":"23505-9998","dob":"1965-12-06","age":"","mstatus":"","insh":"20061489*01","cliId":"","pno":"757\/944-8710","cno":"","email":"","ename":"","eno":"","pphy":"VILLATE PRIETO, SUSANA MD","ppno":"757\/278-2240","pcpadd":"155 KINGSLEY LN STE 400","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23505,"pcpcounty":"","pcpid":"","pcpname":"DEPAUL MEDICAL ASSOCIATES","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/489-6469","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F41.9","E11.9","I10.","F33.1","F41.1","R07.9","M54.5","E05.90","J06.9","I25.10","E78.00","E55.9","N87.0","R42.","I25.83","F32.9","Z20.828","U07.1","B37.3","Z86.79","E11.69","E78.5","Z88.8","Z88.1","Z88.0","Z88.2","R53.83","H81.312","K59.00","Z87.891","E11.8","R05.","F33.2","F06.8","G47.00","R53.1","R06.02","Z68.26","R29.898","M54.9","Z68.27","Z86.19","F69.","R19.00","Z98.890","Z12.11","Z68.25","Z87.828","F30.2","N30.00","M54.6","E13.65","F50.81","R19.8","R26.81","NO DATA","R82.90","Z79.899","E11.65"],"date":["2021-02-25","2022-02-15","2022-09-28","2022-11-14","2022-11-14","2020-10-31","2021-02-16","2022-11-01","2022-07-02","2020-12-23","2021-02-25","2020-12-23","2020-12-23","2020-12-23","2020-12-23","2021-02-25","2022-07-02","2021-09-02","2022-04-14","2020-11-16","2020-12-14","2020-12-14","2022-04-14","2022-04-14","2022-04-14","2022-04-14","2021-11-05","2020-02-21","2020-02-21","2022-09-28","2020-05-08","2020-07-19","2021-02-23","2020-02-21","2020-05-08","2020-10-14","2022-09-28","2022-06-22","2022-09-28","2022-04-14","2021-05-05","2021-09-15","2022-11-14","2020-08-10","2021-02-25","2021-02-25","2019-12-16","2019-12-16","2022-08-08","2022-04-14","2022-04-14","2022-04-14","2022-11-14","2022-04-14","2022-09-28","2022-02-15","2022-02-15","2022-04-14","2022-04-14"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}}]},{"t":"Covid Screening","q":[{"a":[]}]},{"t":"Self-Assessment and Social History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":{"indx":[false,false],"comment":["",""],"score":["",""]}},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Activities of Daily Living","q":[{"a":[]}]},{"t":"Medical History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Family History","q":[{"a":[]}]},{"t":"Preventive Care","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","31604001870","VITAMIN","TAB 1000UNIT","30","Select","Select",""],["","65862019301","FLUOXETINE","CAP 20MG","30","Select","Select",""],["","00002143380","TRULICITY","INJ 0.75\/0.5","2","Select","Select",""],["","","BD  PEN NEEDL","MIS 31GX5MM","","Select","Select",""],["","00574110404","BROM\/PSE\/DM","SYP ","118","Select","Select",""],["","","NOVOLOG","INJ FLEXPEN","","Select","Select",""],["","00002771559","BASAGLAR","INJ 100UNIT","15","Select","Select",""],["","23155007101","METHIMAZOLE","TAB 10MG","120","Select","Select",""],["","53885027025","ONETOUCH","TES VERIO","25","Select","Select",""],["","00135057617","FLONASE","SPR 50MCG","11","Select","Select",""],["","62332003731","LAMOTRIGINE","TAB 25MG","60","Select","Select",""],["","00173068220","VENTOLIN","AER ","18","Select","Select",""],["","","NITROGLYCERN","SUB 0.4MG","","Select","Select",""],["","16729013716","CLONAZEPAM","TAB 1MG","90","Select","Select",""],["","64980028101","GLIPIZIDE","TAB 10MG","60","Select","Select",""],["","00093005301","BUSPIRONE","TAB 5MG","90","Select","Select",""],["","68682010910","NIFEDIPINE","TAB 60MG ER","30","Select","Select",""],["","55111012105","ATORVASTATIN","TAB 10MG","90","Select","Select",""],["","57664047758","METOPROL","TAB 50MG","60","Select","Select",""],["","57237015901","REPAGLINIDE","TAB 2MG","90","Select","Select",""],["","","CIPROFLOXACN","TAB 500MG","","Select","Select",""],["","00591352530","LIDOCAINE","PAD 0.05","30","Select","Select",""],["","65862017760","CEFDINIR","CAP 300MG","20","Select","Select",""],["","70010077001","METHOCARBAM","TAB 750MG","20","Select","Select",""],["","","FLUCONAZOLE","TAB 150MG","","Select","Select",""],["","67877024201","QUETIAPINE","TAB 25MG","60","Select","Select",""],["","42806071401","BENZONATATE","CAP 100MG","21","Select","Select",""],["","60505265301","TRAZODONE","TAB 50MG","30","Select","Select",""],["","73070010315","INSULIN","INJ FLEXPEN","9","Select","Select",""],["","00088221905","LANTUS","INJ 100\/ML","15","Select","Select",""],["","","MECLIZINE","TAB 25MG","","Select","Select",""],["","00597015230","JARDIANCE","TAB 10MG","30","Select","Select",""],["","60505082901","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","52817033200","CYCLOBENZAPR","TAB 10MG","30","Select","Select",""],["","","ESCITALOPRAM","TAB 10MG","","Select","Select",""],["","45802032566","GUAIFENESIN","TAB 1200 ER","14","Select","Select",""],["","00169413212","OZEMPIC","INJ 2\/1.5ML","2","Select","Select",""],["","51672206200","3","CRE 0.02","21","Select","Select",""],["","00168009960","KETOCONAZOLE","CRE 0.02","60","Select","Select",""],["","00378623101","CITALOPRAM","TAB 10MG","30","Select","Select",""],["","00169406012","VICTOZA","INJ 18MG\/3ML","6","Select","Select",""],["","53885004401","ONE","KIT VERIO FL","1","Select","Select",""],["","00169643810","LEVEMIR","INJ FLEXTOUC","3","Select","Select",""],["","00168008031","HYDROCORT","CRE 0.025","30","Select","Select",""],["","68382009705","PAROXETINE","TAB 10MG","30","Select","Select",""],["","65862052790","VENLAFAXINE","CAP 37.5 ER","30","Select","Select",""],["","","TIZANIDINE","TAB 2MG","","Select","Select",""],["","","DOXEPIN","CAP 10MG","","Select","Select",""],["","","D3","TAB 1000UNIT","","Select","Select",""],["","","INS","INJ FLEXPEN","","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","8","Select","Select",""]]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Review of Systems and Diagnoses","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":[]}]},{"t":"Mini-Cog","q":[{"a":[]},{"a":[]}]},{"t":"Home Safety & Personal Goals","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Active Problem Conditions","q":[{"a":[]}]},{"t":"Patient Summary","q":[{"a1":"","a2":"","a3":"","a4":"","a5":"","a6":"","a7":[],"a8":"","a9":"","a10":[],"a11":"","a12":"","a13":""}]}]}