{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SHAWN ROLLINS","gend":0,"add":"9 DALE DR","city":"PORTSMOUTH","state":"VA","zip":"23704-9998","dob":"1968-01-17","age":"","mstatus":"","insh":"1101078*01","cliId":"","pno":7578032710,"cno":7578032710,"email":"","ename":"","eno":"","pphy":"BHOWMIK, NIHAR MD","ppno":7573990701,"pcpadd":"301 GOODE WAY #103,","pcpcity":"PORTSMOUTH","pcpstate":"VA","pcpzip":"23704-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7573993731,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F11.20","A41.9","R65.20","N17.9","G93.41","E87.2","E83.42","E87.1","E87.6","Z20.822","L03.116","D64.9","E86.1","R59.1","K76.0","J45.20","I10.","F11.10","F44.89","M79.605","R07.9","M25.579","F15.920","F29.","U07.1","G93.40","N28.9","R50.9","Z68.34","Z68.33","D72.829","J45.909","M79.89","R60.0","R41.82","R11.10","F43.10","F41.9","R06.9","R06.00","S82.65XA","V58.89","Z79.899","Z79.82","E66.9","T14.8XXA","Z68.35","I73.9","R79.89","I89.0","R06.02","J45.901","Z79.51","S75.022A","J18.9","R65.10","R53.1","Z87.828","R06.2","R07.89","I87.8","Z86.718","F43.12","R00.0","M79.662","J45.41","S82.892A","V54.16","I49.3","F19.10","R56.9","G47.10","Z99.3","R60.1","Z53.21","Z18.10","W34.00XA","R05.","R26.2","R45.0"],"date":["2022-03-31","2021-09-15","2021-03-30","2021-03-30","2021-03-30","2021-03-25","2021-03-25","2021-03-30","2021-09-15","2021-03-25","2022-08-01","2021-03-30","2021-03-25","2021-03-25","2021-03-25","2021-03-30","2022-09-05","2021-03-25","2021-03-25","2021-05-18","2022-08-25","2022-03-03","2022-08-24","2022-08-24","2021-02-12","2021-03-27","2021-03-27","2021-03-30","2021-03-29","2022-02-23","2021-03-30","2022-04-24","2022-08-01","2021-05-18","2022-04-06","2021-03-30","2022-06-02","2023-09-12","2022-06-04","2022-06-06","2022-02-23","2022-03-03","2022-09-05","2022-03-03","2022-03-03","2022-03-03","2021-04-28","2022-09-21","2021-03-30","2021-09-07","2022-09-05","2022-09-05","2022-09-05","2022-09-21","2021-09-17","2021-09-15","2021-09-15","2021-09-17","2021-09-17","2022-06-08","2022-08-01","2022-08-01","2023-09-12","2021-03-25","2021-02-12","2021-07-28","2022-02-23","2022-03-22","2022-04-24","2021-02-12","2021-02-12","2021-02-12","2022-04-06","2022-08-01","2022-08-25","2021-03-26","2021-05-25","2021-09-17","2022-04-24","2022-04-24"],"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":[["","00781107905","ALPRAZOLAM","1 MG","90","Select","Select",""],["","59310058020","PROAIR RESPI","AER ","1","Select","Select",""],["","70954006020","PREDNISONE","20 MG","10","Select","Select",""],["","00406012401","HYDROCO\/APAP","TAB 7.5-325","12","Select","Select",""],["","69097083512","SERTRALINE","TAB 100MG","30","Select","Select",""],["","59310057922","PROAIR HFA","AER ","8","Select","Select",""],["","00536123201","ASPIRIN","TAB 325MG EC","60","Select","Select",""],["","76204020060","ALBUTEROL","NEB 0.00083","2160","Select","Select",""],["","72578005505","DOXYCYCL HYC","CAP 100MG","20","Select","Select",""],["","64380071207","BENZONATATE","CAP 100MG","30","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","70377002811","ATORVASTATIN","TAB 20MG","30","Select","Select",""],["","68180072003","AMLODIPINE","TAB 5MG","30","Select","Select",""],["","00186037020","SYMBICORT","160-4.5MCG","10.2","Select","Select",""],["","00310737020","BUDES\/FORMOT","AER 160-4.5","10","Select","Select",""],["","68180035302","SERTRALINE HCL","100 MG","30","Select","Select",""],["","76204020060","ALBUTEROL SULFATE","2.5 MG\/3ML","540","Select","Select",""],["","00054074287","ALBUTEROL SULFATE HFA","90 MCG","6.7","Select","Select",""],["","00310737020","BUDESONIDE-FORMOTEROL FUMARATE","160-4.5MCG","10.2","Select","Select",""],["","43598083105","ATORVASTATIN CALCIUM","20 MG","30","Select","Select",""],["","68382070718","DOXYCYCLINE MONOHYDRATE","100 MG","20","Select","Select",""],["","29300039710","AMLODIPINE BESYLATE","5 MG","30","Select","Select",""],["","51991070605","ALPRAZOLAM TAB","1MG","90","Select","Select",""],["","59310058020","PROAIR RESPI AER","","1","Select","Select",""],["","70954006020","PREDNISONE TAB","20MG","10","Select","Select",""],["","00406012401","HYDROCO\/APAP TAB","7.5-325","10","Select","Select",""],["","59310057922","PROAIR HFA AER","","8","Select","Select",""],["","00536123201","ASPIRIN TAB","325MG EC","60","Select","Select",""],["","00093317431","ALBUTEROL AER HFA","","8","Select","Select",""],["","69097083512","SERTRALINE TAB","100MG","30","Select","Select",""],["","64380071207","BENZONATATE CAP","100MG","30","Select","Select",""],["","00054327099","FLUTICASONE SPR","50MCG","16","Select","Select",""],["","72578005505","DOXYCYCL HYC CAP","100MG","20","Select","Select",""],["","00310737020","BUDES\/FORMOT AER","160-4.5","10","Select","Select",""],["","70377002811","ATORVASTATIN TAB","20MG","30","Select","Select",""],["","68180072003","AMLODIPINE TAB","5MG","30","Select","Select",""],["","76204020060","ALBUTEROL NEB","0.083%","720","Select","Select",""],["","00186037020","SYMBICORT AER","160-4.5","10","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":""}]}]}