{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"FRANCINE GREEN","gend":1,"add":"100 CANDLEWOOD WAY APT A","city":"NEWPORT NEWS","state":"VA","zip":"23606-9998","dob":"1969-07-06","age":"","mstatus":"","insh":"20028194*01","cliId":"","pno":7573800290,"cno":7573800290,"email":"","ename":"","eno":"","pphy":"JOHNSON, TELYCIA MARIE DO","ppno":7578748400,"pcpadd":"15425H WARWICK BLVD,","pcpcity":"NEWPORT NEWS","pcpstate":"VA","pcpzip":"23607-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7579472001,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["U07.1","E11.9","I10.","M32.9","Z86.711","Z79.01","Z98.84","R07.0","R52.","S09.90XA","M25.571","M25.561","V54.26","M17.0","M17.11","E66.01","E04.9","Z01.810","R00.2","L65.9","I73.00","Z68.44","G47.30","E78.00","I74.9","M25.512","E11.65","Z98.890","Z13.31","J30.9","H26.491","J30.1","J30.89","J30.2","J34.9","R09.82","G47.33","H90.5","T78.1XXA","J35.1","M25.532","M25.642","M25.632","M62.81","Z01.82","K21.9","J30.81","M13.89","R26.89","H40.023","NO DATA","Z79.899","M54.5","M47.816","M51.36","G89.29","M25.562","J30.5","R09.81","Z91.018","R06.02","M06.4","E55.9","M25.50","M65.312","R76.8","E78.5","I26.99","E04.1","H26.492","J03.90","J35.01","R42.","S80.01XA","W01.0XXA","Y92.008","R94.31","E11.3293","K95.09","R13.10","K66.0","M25.462","M65.4","L93.2","Z90.49","Z86.16","Z98.42","Z98.41","Z96.1","D64.9","H60.63","H10.13","Z68.42","H16.223","Z01.818","H16.221","H16.222","E27.8","R93.89","M19.90","R26.81","R19.7","Z79.84","Z79.1","Z88.8","J39.2","R05.9","Z20.822","H53.19","H43.812","H35.62","S83.241A","W18.00XA","E11.3292"],"date":["2022-01-15","2023-09-21","2023-08-25","2023-08-25","2023-05-15","2022-09-14","2023-08-25","2022-01-15","2022-02-24","2022-02-24","2022-02-24","2022-08-13","2022-04-08","2022-03-17","2022-07-11","2023-08-25","2022-12-16","2022-06-22","2022-12-07","2023-05-15","2023-05-15","2023-08-25","2022-11-15","2023-08-25","2023-08-25","2022-10-18","2023-05-05","2023-08-25","2023-01-24","2023-08-24","2023-06-14","2023-08-30","2023-08-30","2021-12-02","2021-12-02","2021-12-02","2023-06-26","2023-06-26","2023-05-16","2023-06-26","2021-10-07","2021-10-07","2021-10-07","2021-10-07","2023-05-25","2023-06-26","2023-08-30","2023-05-15","2021-04-01","2023-06-14","2023-06-14","2023-07-17","2021-08-10","2021-12-13","2021-08-10","2022-06-08","2022-04-05","2021-10-26","2022-01-15","2023-06-26","2021-12-01","2021-12-17","2021-12-13","2021-12-13","2021-12-13","2021-12-17","2023-05-05","2022-02-01","2023-05-04","2021-01-11","2021-11-04","2021-12-02","2023-06-26","2022-03-03","2022-03-03","2022-03-03","2022-12-16","2022-12-14","2023-01-17","2023-01-17","2023-01-17","2021-06-10","2021-08-24","2021-12-01","2022-02-24","2022-02-24","2022-02-24","2022-02-24","2022-02-24","2022-06-08","2023-06-26","2023-06-26","2023-09-21","2021-12-28","2022-12-09","2021-12-28","2021-12-28","2022-03-24","2022-03-12","2023-02-09","2022-03-15","2023-02-20","2022-01-12","2022-01-12","2022-01-12","2022-01-12","2022-01-15","2022-01-15","2022-04-01","2022-06-07","2022-06-07","2022-04-04","2022-04-05","2022-06-07"],"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":[]},{"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":[["","55111032201","GLIMEPIRIDE","4 MG","180","Select","Select",""],["","68462038730","SOLIFENACIN","TAB 10MG","30","Select","Select",""],["","50458057930","XARELTO","20 MG","90","Select","Select",""],["","31604002674","VITAMIN D","3 50 MCG","30","Select","Select",""],["","67877056310","METFORMIN","TAB 1000MG","60","Select","Select",""],["","00093727298","PIOGLITAZONE","TAB 30MG","30","Select","Select",""],["","60432046400","LIDOCAINE","SOL 2% VISC","100","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","59779035926","TUSSIN DM","LIQ 10-100\/5","118","Select","Select",""],["","00536116134","MUCUS RELIEF","TAB 30-600ER","68","Select","Select",""],["","65862057490","MONTELUKAST","TAB 10MG","30","Select","Select",""],["","43598072101","HYDROXYCHLOR","TAB 200MG","60","Select","Select",""],["","70377002711","ATORVASTATIN","TAB 10MG","90","Select","Select",""],["","00245003660","PREVALITE","4 G","60","Select","Select",""],["","68180098003","LISINOPRIL","10 MG","90","Select","Select",""],["","69842031278","8HR PAIN ER","TAB 650MG","180","Select","Select",""],["","00054418125","DEXAMETHASON","TAB 1MG","1","Select","Select",""],["","68180051801","LISINOP\/HCTZ","TAB 10-12.5","90","Select","Select",""],["","42858010201","OXYCOD\/APAP","TAB 5-325MG","10","Select","Select",""],["","65862085901","FAMOTIDINE","20 MG","60","Select","Select",""],["","17478062312","SOD CHLORIDE","SOL 5% OP","15","Select","Select",""],["","31604002674","D3","TAB 2000UNIT","30","Select","Select",""],["","80681017000","VITAMIN D3","TAB 50MCG","30","Select","Select",""],["","67877042260","CHOLESTYRAM","POW 4GM LITE","60","Select","Select",""],["","59267102501","PFIZER VACC","INJ ADLT RTU","0","Select","Select",""],["","65862057490","MONTELUKAST SODIUM","10 MG","90","Select","Select",""],["","43598072101","HYDROXYCHLOROQUINE SULFATE","200 MG","60","Select","Select",""],["","17478062312","SODIUM CHLORIDE","5 %","45","Select","Select",""],["","00093727298","PIOGLITAZONE HCL","30 MG","90","Select","Select",""],["","67877056310","METFORMIN HCL","1000 MG","180","Select","Select",""],["","68462038730","SOLIFENACIN SUCCINATE","10 MG","30","Select","Select",""],["","67877042260","CHOLESTYRAMINE LIGHT","4 G","60","Select","Select",""],["","70377002711","ATORVASTATIN CALCIUM","10 MG","90","Select","Select",""],["","68180051801","LISINOPRIL-HYDROCHLOROTHIAZIDE","10-12.5MG","90","Select","Select",""],["","42858010201","OXYCODONE-ACETAMINOPHEN","5 MG-325MG","28","Select","Select",""],["","00093598627","EPINEPHRINE","0.3MG\/0.3","2","Select","Select",""],["","00168035730","LIDOCAINE-PRILOCAINE","2.5 %-2.5%","30","Select","Select",""],["","69097012303","TOPIRAMATE","50 MG","180","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":""}]}]}