{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"RENATA D WESLEY","gend":1,"add":"5020 WAVERTON CT APT E","city":"CHESAPEAKE","state":"VA","zip":"23324-9998","dob":"1974-08-19","age":"","mstatus":"","insh":"20037146*01","cliId":"","pno":7572271417,"cno":7572271417,"email":"","ename":"","eno":"","pphy":"ZHAO, WEI MD","ppno":7574367888,"pcpadd":"675 N BATTLEFIELD BLVD,","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":"23320-9998","pcpcounty":"","pcpid":"","pcpname":"Battlefield Medical Associates","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7575485669,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F51.04","F90.0","F43.12","F33.1","I26.99","C50.912","I10.","R19.7","Z17.0","Z79.899","Z79.01","D64.81","G62.0","T45.1X5A","C50.919","R82.90","H00.14","R53.0","K52.1","R55.","C50.412","J45.909","N64.4","Z85.3","M17.11","C50.812","Z79.810","E83.42","R07.89","M25.511","G44.209","R23.2","T38.6X5A","N76.0","Z08.","D72.819","C50.212","Z80.3","R92.2","Z01.812","Z20.822","Z01.818","R11.0","M25.561","M17.12","S99.922A","Z79.51","F90.9","Z88.5","Z88.6","Z98.84","Z90.710","Z98.890","Z82.49","M79.675","M25.461","NO DATA","S52.225A","M79.602","M21.061","M25.562","M17.0","S90.122A","H40.013","H40.053","H52.03","H52.223","H52.4","I26.93","D72.829","H10.31","H00.011","R30.0","V54.12","M25.532","Z86.711","L30.9","D23.9","Z71.9","R07.9","Z86.16","Z92.3","J20.9","U07.1","G89.29","Z00.00","N62.","L30.4","M25.519","M54.14","N90.60","D05.12","Z71.89","F32.9","Z92.21","E87.1","E87.6","E53.8","Z90.12","E86.0","Z51.0","I50.30","N61.0","N76.89","N65.1","V58.89","A59.01","Z11.3","S90.112A","Z01.810","T45.1X1A","I51.7","Z09.","R05.","R51.9","N95.1","D24.2","M25.462","Z23.","Z51.11"],"date":["2023-09-05","2023-09-05","2023-09-05","2023-09-05","2023-07-20","2023-07-20","2023-07-20","2021-07-02","2023-02-13","2022-10-08","2022-10-08","2022-08-18","2022-08-18","2022-08-18","2022-05-26","2021-09-01","2021-09-10","2021-10-28","2021-09-16","2021-10-11","2022-08-09","2023-07-20","2022-05-16","2023-07-05","2022-12-29","2022-05-26","2023-06-07","2022-05-26","2022-10-08","2022-10-08","2022-10-08","2022-11-10","2022-11-10","2023-01-23","2023-06-07","2023-06-07","2021-10-28","2021-06-16","2021-04-15","2021-06-11","2021-06-11","2022-06-29","2021-10-07","2023-07-20","2022-12-05","2022-08-27","2022-10-08","2022-10-08","2022-10-08","2022-10-08","2022-10-08","2022-10-08","2022-10-08","2022-08-27","2022-10-24","2022-12-16","2022-10-02","2022-01-17","2022-01-17","2022-08-29","2022-10-24","2023-08-28","2022-10-24","2023-08-21","2023-08-21","2023-08-21","2023-08-21","2023-08-21","2021-06-30","2021-07-02","2021-08-19","2021-08-19","2021-09-04","2022-04-19","2022-04-19","2022-10-08","2022-10-04","2022-10-04","2022-10-04","2022-10-08","2022-10-08","2022-10-08","2023-03-14","2023-04-11","2023-07-20","2023-07-20","2021-01-25","2021-01-25","2021-01-25","2021-01-25","2021-12-17","2021-05-13","2021-06-07","2021-07-01","2021-07-01","2021-06-30","2021-06-30","2021-06-30","2021-06-30","2021-10-11","2021-10-20","2022-03-24","2022-05-05","2022-12-16","2021-05-13","2022-02-10","2022-07-23","2022-07-23","2022-08-26","2021-10-18","2021-10-18","2021-10-18","2021-07-07","2021-07-19","2021-08-05","2021-12-17","2023-07-05","2023-08-28","2021-08-26","2021-10-18"],"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":[["","66993058597","FLUTIC\/SALME","AER 250\/50","60","Select","Select",""],["","00173069600","ADVAIR DISKU","AER 250\/50","60","Select","Select",""],["","31722099601","HYDROCO\/APAP","TAB 5-325MG","12","Select","Select",""],["","16571020210","DICLOFENAC","TAB 50MG DR","30","Select","Select",""],["","50228018001","GABAPENTIN","CAP 300MG","60","Select","Select",""],["","00093216568","NALOXONE HCL","SPR ","2","Select","Select",""],["","59651030030","TAMOXIFEN","TAB 20MG","30","Select","Select",""],["","68462019001","NAPROXEN","500 MG","30","Select","Select",""],["","68180035209","SERTRALINE","TAB 50MG","90","Select","Select",""],["","42806034401","AMPHET\/DEXTR","TAB 20MG","30","Select","Select",""],["","59746011306","PROCHLORPER","TAB 5MG","30","Select","Select",""],["","00003089321","ELIQUIS","2.5 MG","60","Select","Select",""],["","65862018830","ONDANSETRON","TAB 8MG","30","Select","Select",""],["","43547035210","LISINOPRIL","5 MG","30","Select","Select",""],["","13107008301","LORAZEPAM","TAB 0.5MG","60","Select","Select",""],["","00172208380","HYDROCHLOROT","TAB 25MG","90","Select","Select",""],["","70010016201","LORATADINE","10 MG","30","Select","Select",""],["","65162027210","SMZ\/TMP DS","TAB 800-160","6","Select","Select",""],["","50383070016","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","16571066450","METRONIDAZOL","TAB 500MG","14","Select","Select",""],["","59310057922","PROAIR HFA","AER ","8","Select","Select",""],["","57237000511","FLUCONAZOLE","150 MG","2","Select","Select",""],["","29300022019","MONTELUKAST","TAB 10MG","90","Select","Select",""],["","00406051201","OXYCOD\/APAP","TAB 5-325MG","10","Select","Select",""],["","68382005101","MELOXICAM","TAB 15MG","30","Select","Select",""],["","45802006435","TRIAMCINOLON","CRE 0.001","60","Select","Select",""],["","70010077001","METHOCARBAM","TAB 750MG","20","Select","Select",""],["","65862052790","VENLAFAXINE","CAP 37.5 ER","30","Select","Select",""],["","00093220301","METOCLOPRAM","TAB 10MG","15","Select","Select",""],["","00172572860","FAMOTIDINE","TAB 20MG","20","Select","Select",""],["","42806040021","METHYLPRED","TAB 4MG","21","Select","Select",""],["","68180096301","ALBUTEROL SULFATE HFA","90 MCG","25.5","Select","Select",""],["","62332025118","AZITHROMYCIN","250 MG","6","Select","Select",""],["","72516003001","METOPROLOL SUCCINATE","25 MG","30","Select","Select",""],["","59651030030","TAMOXIFEN CITRATE","20 MG","30","Select","Select",""],["","65862052790","VENLAFAXINE HCL ER","37.5 MG","30","Select","Select",""],["","29300022019","MONTELUKAST SODIUM","10 MG","30","Select","Select",""],["","00527150537","DEXTROAMPHETAMINE-AMPHETAMINE","20 MG","30","Select","Select",""],["","69097083412","SERTRALINE HCL","50 MG","90","Select","Select",""],["","11822328110","CLOTRIMAZOLE","1 %","45","Select","Select",""],["","59746017506","PREDNISONE","20 MG","10","Select","Select",""],["","72888001405","CYCLOBENZAPRINE HCL","10 MG","30","Select","Select",""],["","00173069700","ADVAIR DISKUS","500-50 MCG","60","Select","Select",""],["","55111078301","FEXOFENADINE HCL","60 MG","30","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":""}]}]}