{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ANGELA  L WILSON","gend":1,"add":"1501 SHIRE LN STE 211","city":"CHESAPEAKE","state":"VA","zip":"23325-9998","dob":"1961-07-16","age":"","mstatus":"","insh":"20037607*01","cliId":"","pno":7576326871,"cno":7576326871,"email":"","ename":"","eno":"","pphy":"MUSSELMANI, ZATTAM MD","ppno":7575433557,"pcpadd":"1422 POINDEXTER ST,","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":"23324-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7575430053,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F34.1","E55.9","D52.9","E78.2","R73.03","NO DATA","R10.84","J06.9","J18.9","R07.81","F17.210","Z20.822","F17.200","J84.10","Z79.899","G24.3","R63.4","J30.89","Z76.89","R68.81","R05.","R68.83","J30.9","R05.9","R13.10","J30.1","K21.9","R10.13","R11.2","H25.13","H52.03","H52.221","H52.4","R63.6","L20.84","Z12.31","Z12.11","R07.89","R25.2","M25.512","Z20.828"],"date":["2023-07-11","2022-08-04","2021-12-16","2021-12-16","2022-08-24","2022-08-24","2021-08-04","2023-02-07","2021-11-16","2021-11-16","2021-11-16","2021-11-16","2022-08-04","2022-08-04","2022-12-28","2021-12-14","2021-08-10","2021-08-02","2021-08-02","2021-08-02","2021-09-16","2021-08-28","2021-09-16","2023-02-07","2021-10-12","2021-10-12","2021-10-12","2021-10-30","2021-10-30","2022-04-14","2022-04-14","2022-04-14","2022-04-14","2022-08-04","2022-08-04","2022-08-04","2022-08-04","2021-08-28","2022-06-16","2022-06-16","2021-01-22"],"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":[["","68180063509","ATORVASTATIN","TAB 10MG","30","Select","Select",""],["","11534016501","FOLIC ACID","TAB 1MG","30","Select","Select",""],["","64380073706","VITAMIN D","2 1250 MCG","4","Select","Select",""],["","11822619070","RA COUGH DM","SUS 30MG\/5ML","140","Select","Select",""],["","00121092616","PROMETH VC","SYP 6.25-5\/5","140","Select","Select",""],["","82607066026","FLOWFLEX","KIT TEST","8","Select","Select",""],["","80777027399","MODERNA VAC","INJ COVID-19","0","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","18","Select","Select",""],["","59310057922","PROAIR HFA","AER ","8","Select","Select",""],["","64380071206","BENZONATATE","CAP 100MG","42","Select","Select",""],["","31722070290","LOSARTAN POT","TAB 100MG","30","Select","Select",""],["","16729017017","ESCITALOPRAM","TAB 20MG","30","Select","Select",""],["","00185067601","HYDROXYZ PAM","CAP 50MG","90","Select","Select",""],["","00173068220","VENTOLIN HFA","AER ","18","Select","Select",""],["","00555060702","MEGESTROL AC","TAB 40MG","60","Select","Select",""],["","70010075401","METHOCARBAM","TAB 500MG","90","Select","Select",""],["","49884015576","VARENICLINE","TAB 0.5MG","60","Select","Select",""],["","51672129303","CLOBETASOL","SOL 0.0005","300","Select","Select",""],["","58160082311","SHINGRIX","INJ 50\/0.5ML","1","Select","Select",""],["","00113095828","COUGH DM","SUS 30MG\/5ML","148","Select","Select",""],["","70436015541","PROMETHAZINE","SOL DM","200","Select","Select",""],["","51672135708","FLUOCIN ACET","OIL 0.01% SC","118","Select","Select",""],["","00093506101","HYDROXYZ HCL","TAB 25MG","60","Select","Select",""],["","00316019316","HYDROCORT","CRE 0.025","454","Select","Select",""],["","68180013601","ESCITALOPRAM OXALATE","20 MG","30","Select","Select",""],["","42192060716","BROMPHENIRAMINE-PSEUDOEPHED-DM","2-30-10\/5","140","Select","Select",""],["","70010075401","METHOCARBAMOL","500 MG","90","Select","Select",""],["","64380016001","MEGESTROL ACETATE","400MG\/10ML","150","Select","Select",""],["","00185067605","HYDROXYZINE PAMOATE","50 MG","90","Select","Select",""],["","51672129303","CLOBETASOL PROPIONATE","0.05 %","250","Select","Select",""],["","62332025118","AZITHROMYCIN","250 MG","6","Select","Select",""],["","00121092616","PROMETHAZINE VC","5-6.25MG\/5","140","Select","Select",""],["","70436015541","PROMETHAZINE-DM","6.25-15\/5","118","Select","Select",""],["","66993001968","ALBUTEROL SULFATE HFA","90 MCG","18","Select","Select",""],["","00121092616","PROMETH VC SYP","6.25-5\/5","140","Select","Select",""],["","11534016501","FOLIC ACID TAB","1MG","30","Select","Select",""],["","11822619070","RA COUGH DM SUS","30MG\/5ML","140","Select","Select",""],["","64380073706","VITAMIN D CAP","50000UNT","4","Select","Select",""],["","68180063509","ATORVASTATIN TAB","10MG","30","Select","Select",""],["","80777027399","MODERNA VAC INJ COVID-","19","0","Select","Select",""],["","82607066026","FLOWFLEX KIT TEST","","8","Select","Select",""],["","64380071206","BENZONATATE CAP","100MG","42","Select","Select",""],["","66993001968","ALBUTEROL AER HFA","","18","Select","Select",""],["","16729017017","ESCITALOPRAM TAB","20MG","30","Select","Select",""],["","00185067601","HYDROXYZ PAM CAP","50MG","90","Select","Select",""],["","49884015576","VARENICLINE TAB","0.5MG","60","Select","Select",""],["","59310057922","PROAIR HFA AER","","8","Select","Select",""],["","00173068220","VENTOLIN HFA AER","","18","Select","Select",""],["","31722070290","LOSARTAN POT TAB","100MG","30","Select","Select",""],["","70010075401","METHOCARBAM TAB","500MG","90","Select","Select",""],["","58160082311","SHINGRIX INJ","50\/0.5ML","1","Select","Select",""],["","51672129303","CLOBETASOL SOL","0.05%","300","Select","Select",""],["","00555060702","MEGESTROL AC TAB","40MG","60","Select","Select",""],["","70436015541","PROMETHAZINE SOL DM","","120","Select","Select",""],["","00316019316","HYDROCORT CRE","2.5%","454","Select","Select",""],["","00093506101","HYDROXYZ HCL TAB","25MG","60","Select","Select",""],["","51672135708","FLUOCIN ACET OIL","0.01% SC","118","Select","Select",""],["","00113095828","COUGH DM SUS","30MG\/5ML","148","Select","Select",""],["","00186037020","SYMBICORT","160-4.5MCG","10.2","Select","Select",""],["","70010013701","NAPROXEN","250 MG","20","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":""}]}]}