{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DERRICK GRAVES","gend":0,"add":"6210 CENTENARY DR APT B","city":"PORTSMOUTH","state":"VA","zip":"23703-9998","dob":"1977-04-21","age":"","mstatus":"","insh":"2078716*01","cliId":"","pno":"757\/378-4981","cno":"","email":"","ename":"","eno":"","pphy":"ABDELSHAHEED, SAMIR T MD","ppno":"757\/488-3333","pcpadd":"3925 PORTSMOUTH BLVD","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":23321,"pcpcounty":"","pcpid":"","pcpname":"Family Medicine Healthcare, PLLC","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/488-0007","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G40.909","I42.8","E78.5","I10.","I25.2","Z76.0","Z86.74","Z87.891","Z79.899","Z79.82","R94.31","I47.2","Z95.810","I46.9","I95.9","Z45.02","R07.9","Z48.812","I49.01","I42.9","J45.909","E55.9","R00.1","Z20.828","I42.0","Z71.89","J96.01","R53.81","R57.0","R07.89","I51.9","R56.9","D12.3","R50.9","R11.10","Z45.2","Z68.35","J96.02","J15.212","Z51.5","K59.00","I25.5","I12.9","N18.9","F10.10","E11.22","I50.22","I13.10","V58.69","E03.9","J45.40","E87.6","T82.599A","T84.9XXA","N18.3","I45.4","Z79.51","I49.3","Z91.14","I47.1","T85.698A","J45.20","F10.21","Z82.49","Z82.5","Z22.322","L84.","T82.198A","I11.9","NO DATA","R41.82","I49.9","T83.498A","J45.21","Z20.822","E66.9","Z91.018","R05.9"],"date":["2020-12-23","2020-12-23","2020-12-23","2020-10-01","2020-01-11","2020-01-11","2020-10-01","2022-10-07","2022-10-07","2020-01-11","2020-08-19","2020-10-01","2022-10-07","2020-08-05","2020-08-05","2020-08-10","2020-08-19","2020-10-01","2020-10-01","2022-10-07","2020-10-01","2020-10-01","2020-03-04","2022-01-26","2020-07-22","2020-08-05","2020-08-05","2020-08-05","2020-08-05","2020-08-19","2020-08-03","2020-02-23","2020-09-09","2020-08-03","2020-08-04","2020-08-05","2020-03-20","2020-07-30","2020-08-04","2020-07-30","2020-07-30","2020-07-30","2020-07-30","2020-07-30","2020-07-30","2020-02-23","2020-02-23","2020-02-23","2020-02-23","2020-02-23","2020-02-23","2020-02-23","2019-03-27","2019-09-04","2019-09-05","2019-09-05","2019-11-10","2019-11-10","2019-11-12","2019-03-29","2019-11-04","2019-03-27","2019-03-27","2019-03-27","2019-03-27","2019-03-27","2019-01-29","2019-03-27","2019-11-10","2019-11-10","2019-06-27","2019-11-04","2019-09-04","2022-10-07","2022-10-07","2022-10-07","2022-10-07","2022-10-07"],"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":[["","59310057922","PROAIR","AER ","8","Select","Select",""],["","","AMLODIPINE","TAB 5MG","","Select","Select",""],["","00168000215","TRIAMCINOLON","CRE 0.005","30","Select","Select",""],["","00228257111","INDAPAMIDE","TAB 2.5MG","30","Select","Select",""],["","00173068220","VENTOLIN","AER ","18","Select","Select",""],["","00093874001","MEXILETINE","CAP 200MG","60","Select","Select",""],["","69097052444","DICLOFENAC","GEL 0.01","100","Select","Select",""],["","29300012510","MELOXICAM","TAB 15MG","30","Select","Select",""],["","00527260137","METOPROL","TAB 50MG ER","30","Select","Select",""],["","66993007996","FLUTICAS","AER 110MCG","12","Select","Select",""],["","68180052002","LISINOP\/HCTZ","TAB 20-25MG","30","Select","Select",""],["","76204020025","ALBUTEROL","NEB 0.00083","75","Select","Select",""],["","13668001512","LEVETIRACETA","TAB 500MG","60","Select","Select",""],["","68462019005","NAPROXEN","TAB 500MG","60","Select","Select",""],["","00173071920","FLOVENT","AER 110MCG","36","Select","Select",""],["","00093031101","LOPERAMIDE","CAP 2MG","20","Select","Select",""],["","00054001925","PREDNISONE","TAB 50MG","5","Select","Select",""],["","62332046431","VITAMIN","CAP 50000","4","Select","Select",""],["","67877056110","METFORMIN","TAB 500MG","90","Select","Select",""],["","","KETOCONAZOLE","CRE 0.02","","Select","Select",""],["","00093314705","CEPHALEXIN","CAP 500MG","28","Select","Select",""],["","68382022714","AMIODARONE","TAB 200MG","30","Select","Select",""],["","","DOXYCYCL","TAB 100MG","","Select","Select",""],["","76204060030","IPRATROPIUM\/","SOL ALBUTER","360","Select","Select",""],["","29300034905","ALLOPURINOL","TAB 100MG","30","Select","Select",""],["","00085113204","PROVENTIL","AER HFA","20","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","14","Select","Select",""],["","59267100001","PFIZER","INJ COVID-19","0","Select","Select",""],["","00904674460","ASPIRIN","TAB 325MG","30","Select","Select",""],["","00185434601","QUINIDINE","TAB 200MG","135","Select","Select",""],["","37864000052","THERA-M","TAB ","30","Select","Select",""],["","","THERAPEUTIC-","TAB M\/LUTEIN","","Select","Select",""],["","","KLOR-CON","TAB 20MEQ ER","","Select","Select",""],["","","CVS","TAB 325MG","","Select","Select",""],["","","METHYLPRED","TAB 4MG","","Select","Select",""],["","65862050320","AMOX\/K","TAB 875-125","20","Select","Select",""],["","62037099901","POT  CL MICRO","TAB 20MEQ ER","30","Select","Select",""],["","00173087410","ARNUITY","INH 100MCG","30","Select","Select",""],["","","ATORVASTATIN","TAB 20MG","","Select","Select",""],["","","AZITHROMYCIN","TAB 250MG","","Select","Select",""],["","","CLEARLAX","POW ","","Select","Select",""],["","83490031065","VIOS","MIS SYSTEM","1","Select","Select",""],["","","REFRESH","DRO OP","","Select","Select",""],["","","DOXYCYC","CAP 100MG","","Select","Select",""],["","","BISACODYL","SUP 10MG","","Select","Select",""],["","","MUPIROCIN","OIN 0.02","","Select","Select",""],["","","FAMOTIDINE","TAB 20MG","","Select","Select",""],["","","ACID","TAB 20MG","","Select","Select",""],["","","BP","MIS AUTO ARM","","Select","Select",""],["","49035041690","EQ","TAB 325MG","30","Select","Select",""],["","63481068447","VOLTAREN","GEL 0.01","100","Select","Select",""],["","63824000832","MUCINEX","TAB 600MG ER","20","Select","Select",""],["","68382060010","POT  CHLORIDE","TAB 10MEQ ER","15","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":""}]}]}