{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"NANNIE  D GARDNER","gend":1,"add":"882 ST PAULS BLVD","city":"NORFOLK","state":"VA","zip":"23510-9998","dob":"1974-12-04","age":"","mstatus":"","insh":"20040633*01","cliId":"","pno":7573764105,"cno":7573764105,"email":"","ename":"","eno":"","pphy":"BEVERLY, VERNIS MD","ppno":7576230095,"pcpadd":"SUITE 1 1401 TIDEWATER DR","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":"23504-9998","pcpcounty":"","pcpid":"","pcpname":"Adult and Pediatric Medical Associates","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7576231203,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F33.1","NO DATA","R05.9","B34.9","Z20.822","J45.909","I10.","B20.","Z23.","S22.31XA","S20.212A","J44.9","K44.9","R29.6","F17.210","R07.81","M22.2X1","S80.02XA","R53.1","J15.9","R06.02","R60.9","M19.90","E66.3","R91.8","J06.9","Z21.","Z79.899","R69."],"date":["2023-04-17","2022-12-26","2022-12-26","2022-12-26","2022-12-26","2022-12-26","2023-03-15","2023-02-23","2022-10-13","2023-03-15","2023-03-15","2023-03-15","2023-03-15","2023-03-15","2023-03-15","2023-03-15","2021-06-16","2021-06-16","2023-02-23","2023-01-21","2023-01-21","2022-06-17","2022-06-17","2022-06-17","2023-03-15","2022-12-26","2022-12-26","2022-12-26","2022-12-26"],"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":[["","68180096301","ALBUTEROL","AER HFA","8","Select","Select",""],["","00186037020","SYMBICORT","160-4.5MCG","10.2","Select","Select",""],["","16729018201","HYDROCHLOROT","TAB 12.5MG","30","Select","Select",""],["","69097044602","ATAZANAVIR","CAP 300MG","30","Select","Select",""],["","59310057922","PROAIR HFA","AER ","8","Select","Select",""],["","00074333330","NORVIR","TAB 100MG","30","Select","Select",""],["","00310737220","BUDES\/FORMOT","AER 80-4.5","10","Select","Select",""],["","61958070101","TRUVADA","TAB 200-300","30","Select","Select",""],["","45802016000","DICLOFENAC","GEL 0.01","100","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","00054040713","RITONAVIR","100 MG","30","Select","Select",""],["","59267100003","PFIZER VACC","INJ COVID-19","0","Select","Select",""],["","65862035430","EMTR\/TENOFOV","TAB 200-300","30","Select","Select",""],["","68382005101","MELOXICAM","TAB 15MG","30","Select","Select",""],["","65862019301","FLUOXETINE","CAP 20MG","30","Select","Select",""],["","50111056001","TRAZODONE","TAB 50MG","30","Select","Select",""],["","65862057490","MONTELUKAST","TAB 10MG","30","Select","Select",""],["","00173068220","VENTOLIN HFA","90 MCG","18","Select","Select",""],["","00487990130","ALBUTEROL SULFATE","2.5 MG\/0.5","15","Select","Select",""],["","65862071330","ATAZANAVIR SULFATE","300 MG","30","Select","Select",""],["","00093770456","EMTRICITABINE-TENOFOVIR DISOP","200-300 MG","30","Select","Select",""],["","65162083366","DICLOFENAC SODIUM","1 %","100","Select","Select",""],["","00310737020","BUDESONIDE-FORMOTEROL FUMARATE","160-4.5MCG","10.2","Select","Select",""],["","00228282011","HYDROCHLOROTHIAZIDE","12.5 MG","30","Select","Select",""],["","59746017506","PREDNISONE","20 MG","15","Select","Select",""],["","65162079108","LIDOCAINE","5 %","15","Select","Select",""],["","69238110005","DOXYCYCLINE HYCLATE","100 MG","10","Select","Select",""],["","00143924920","AMOXICILLIN-CLAVULANATE POTASS","875-125 MG","20","Select","Select",""],["","65862057490","MONTELUKAST SODIUM","10 MG","30","Select","Select",""],["","00378797052","IPRATROPIUM BROMIDE","0.2 MG\/ML","62.5","Select","Select",""],["","58602077321","PAIN RELIEF","500 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":""}]}]}