{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BERNARD ALEXANDER","gend":0,"add":"9601 4TH VIEW ST APT 227","city":"NORFOLK","state":"VA","zip":"23503-9998","dob":"1958-08-30","age":"","mstatus":"","insh":"2139386*01","cliId":"","pno":"757\/343-1374","cno":"757\/343-1374","email":"","ename":"","eno":"","pphy":"FEE, ERIC MD","ppno":"757\/587-0157","pcpadd":"7924 CHESAPEAKE BLVD","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23518,"pcpcounty":"","pcpid":"","pcpname":"Bayview Medical Center","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/587-0074","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["U07.1","R06.02","K80.20","R74.0","R79.89","R91.1","Z72.0","M06.9","R11.2","R19.7","I51.89","H40.1131","H10.13","Z96.1","H04.123","G47.33","H20.9","M1A.09X0","NO DATA","M19.041","M19.042","H26.492","S90.31XA","R10.84","M06.89","M47.816","M1A.00X0","Z79.899","K04.7","B18.2","F17.200","K70.0","B34.9","R53.81","R53.83","N17.9","F10.10","R06.00","Z20.828","R42.","R00.1","R06.83","I27.82","I10.","G57.93","B19.10","B19.20","I26.99","I82.409","M54.5","R60.0","E78.00","R91.8","K76.0","R07.9","J18.9","R58.","Z86.711","H16.142","V58.89","H15.013","H40.023","G47.30","Z00.00","M79.604","I80.9","H25.11","H25.812","H04.122","H04.121","I07.1","G89.29","M51.37","F17.210","Z79.82","Z79.52","Z88.6","F10.239","F41.9","F10.20","F51.05","F39.","F99.","R10.13","F10.920","Z86.11","Z86.718","S62.522A","Z23.","G89.4","M54.40","M79.2","M62.838","R68.89","L30.0","Z71.9","H40.1111","R07.0","R51.9","R68.84","R50.9","M13.0","F10.230","Z86.19","Z86.79","F33.1","F51.04","M25.511","M79.89","H25.13","H40.042","R10.32","A41.9","R65.10","E86.9","D72.829","I42.9","Z83.3","Z82.49","Z80.9","Z03.818","N52.9","H40.1121","R06.81","R40.0","Z72.821","M54.42","J02.9","D17.79","R00.0","E87.1","I42.6","E86.0","E78.5","E87.6","S62.525A","S60.312A","I87.2","B35.1","M54.6","M94.0","F10.129"],"date":["2020-06-12","2020-09-10","2022-06-29","2020-04-29","2020-09-10","2022-06-29","2022-03-11","2022-09-07","2022-07-25","2020-09-16","2020-09-15","2022-10-26","2021-02-10","2021-02-10","2022-10-26","2021-02-23","2022-09-28","2022-09-28","2022-09-28","2022-09-28","2022-09-28","2021-10-01","2022-03-11","2022-07-24","2020-06-29","2022-09-07","2020-04-09","2022-09-28","2020-04-22","2020-09-10","2021-09-22","2020-02-20","2020-09-10","2020-09-10","2020-10-04","2020-09-16","2021-08-14","2020-09-10","2020-09-10","2021-03-15","2021-08-20","2021-03-15","2021-03-15","2022-09-07","2021-10-11","2022-09-07","2021-08-20","2021-08-20","2021-08-20","2021-08-20","2021-08-20","2021-08-20","2022-06-23","2022-06-23","2022-07-25","2020-01-07","2020-01-07","2020-09-16","2020-03-19","2020-03-19","2020-08-17","2020-03-19","2020-07-22","2020-07-23","2020-08-10","2020-08-10","2020-08-17","2020-08-17","2020-08-17","2020-08-17","2020-09-12","2021-11-15","2020-09-23","2022-03-11","2020-10-04","2020-10-04","2022-03-11","2021-08-12","2021-08-11","2021-08-16","2021-08-12","2021-08-12","2021-08-12","2022-07-25","2022-07-24","2020-09-11","2020-09-16","2021-04-16","2021-05-12","2021-08-14","2021-08-14","2021-09-22","2021-10-11","2022-01-24","2022-03-23","2022-03-23","2020-08-17","2020-09-12","2021-09-22","2021-09-22","2020-06-10","2020-06-29","2021-08-16","2021-08-16","2021-08-16","2021-08-14","2021-08-13","2022-03-09","2022-03-11","2020-04-14","2020-04-14","2020-06-01","2020-06-07","2020-06-07","2020-06-07","2020-06-07","2020-06-07","2020-06-07","2020-06-07","2020-06-07","2020-06-07","2020-06-12","2020-08-03","2020-09-01","2020-09-01","2020-09-01","2020-09-01","2020-09-13","2021-11-15","2020-03-18","2020-09-10","2020-09-10","2020-09-10","2020-09-10","2020-09-10","2021-03-04","2021-03-04","2021-05-11","2021-05-11","2021-08-16","2022-07-25","2022-07-25"],"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":[]},{"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":[["","69238131209","PREGABALIN","CAP 75MG","90","Select","Select",""],["","65862059801","TAMSULOSIN","CAP 0.4MG","30","Select","Select",""],["","70700010617","CLOBETASOL","OIN 0.0005","60","Select","Select",""],["","59746017306","PREDNISONE","TAB 10MG","60","Select","Select",""],["","60505620202","CYCLOSPORINE","EMU 0.05% OP","60","Select","Select",""],["","00023916360","RESTASIS","EMU 0.0005","60","Select","Select",""],["","00074055402","HUMIRA","INJ 40\/0.4ML","2","Select","Select",""],["","16729013401","ALLOPURINOL","TAB 100MG","30","Select","Select",""],["","50228017805","GABAPENTIN","TAB 800MG","135","Select","Select",""],["","00023932105","ALPHAGAN","SOL 0.001","5","Select","Select",""],["","57237001760","DULOXETINE","CAP 20MG","30","Select","Select",""],["","65162079108","LIDOCAINE","PAD 0.05","30","Select","Select",""],["","65862019105","CYCLOBENZAPR","TAB 10MG","90","Select","Select",""],["","67877022505","MYCOPHENOLAT","TAB 500MG","120","Select","Select",""],["","65862050320","AMOX\/K","TAB 875-125","14","Select","Select",""],["","00143301801","COLCHICINE","CAP 0.6MG","60","Select","Select",""],["","67877019905","AMLODIPINE","TAB 10MG","90","Select","Select",""],["","70748013306","SILDENAFIL","TAB 100MG","6","Select","Select",""],["","24208050307","LOTEMAX","GEL 0.005","10","Select","Select",""],["","31722071390","PANTOPRAZOLE","TAB 40MG","60","Select","Select",""],["","65862039010","ONDANSETRON","TAB 4MG ODT","12","Select","Select",""],["","17478083005","LOTEPREDNOL","GEL 0.005","10","Select","Select",""],["","17478083005","LOTEPRE","GEL 0.005","10","Select","Select",""],["","10702001801","OXYCODONE","TAB 5MG","30","Select","Select",""],["","60505257909","ATORVASTATIN","TAB 20MG","90","Select","Select",""],["","65862007930","TERBINAFINE","TAB 250MG","90","Select","Select",""],["","70010075401","METHOCARBAM","TAB 500MG","90","Select","Select",""],["","68462043518","ACAMPRO","TAB 333MG","180","Select","Select",""],["","65162019010","NAPROXEN","TAB 500MG","20","Select","Select",""],["","65162083366","DICLOFENAC","GEL 0.01","200","Select","Select",""],["","58160088752","FLUARIX","INJ 2021-22","0","Select","Select",""],["","00172392570","DIAZEPAM","TAB 2MG","6","Select","Select",""],["","50458057930","XARELTO","TAB 20MG","30","Select","Select",""],["","31722072320","LEVOFLOXACIN","TAB 750MG","10","Select","Select",""],["","50383008716","GUAIATUSS","SYP 100-10\/5","180","Select","Select",""],["","00781286810","OMEPRAZOLE","CAP 20MG DR","30","Select","Select",""],["","60758011905","PREDNISOLONE","SUS 1% OP","5","Select","Select",""],["","58160082311","SHINGRIX","INJ 50\/0.5ML","1","Select","Select",""],["","00574402435","ERYTHROMYCIN","OIN 5MG\/GM","4","Select","Select",""],["","65862018601","CLINDAMYCIN","CAP 300MG","30","Select","Select",""],["","65162062710","TRAMADOL","TAB 50MG","28","Select","Select",""],["","69238110005","DOXYCYCL","CAP 100MG","8","Select","Select",""],["","24208058559","TROPICAMIDE","SOL 1% OP","2","Select","Select",""],["","00832059011","DIPHEN\/ATROP","TAB ","20","Select","Select",""],["","69315012710","FOLIC","TAB 1000MCG","30","Select","Select",""],["","00093768432","OLOPATADINE","SOL 0.002","5","Select","Select",""],["","00093117401","PENICILLN","TAB 500MG","40","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":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"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":""}]}]}