{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DAVID ELEY","gend":0,"add":"1230 25TH ST APT H","city":"NEWPORT NEWS","state":"VA","zip":"23607-9998","dob":"1959-08-11","age":"","mstatus":"","insh":"20048886*01","cliId":"","pno":7579496127,"cno":7579496127,"email":"","ename":"","eno":"","pphy":"ASPILI, CONCEPCION MD","ppno":7578748400,"pcpadd":"4714 MARSHALL AVE,","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":7579280902,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N20.0","R10.32","T68.XXXA","N13.30","Z02.9","Z98.1","E11.29","I10.","R21.","K59.00","N40.1","N52.8","E29.1","R35.0","E11.65","Z79.4","J44.9","J45.901","L60.2","B35.1","L85.3","R20.2","R23.4","Z71.6","R14.0","R11.2","K59.01","E13.9","N20.2","I12.9","NO DATA","J34.2","J34.3","I45.10","I44.4","I45.2","R09.81","R94.31","Z71.89","M16.11","K59.09","Z86.010","R07.89","E87.6","M25.562","R05.3","M87.052","E11.9","F17.210","Z91.81","J01.11","H61.23","H92.01","J45.40","J98.11","G47.9","R53.81","R53.83","R07.9","N13.2","Z72.0","J30.89","K21.9","R07.0","R49.0","M16.12","M25.552","G89.29","M16.0","E78.5","R74.8","Z12.5","Z79.84","R52.","H90.A21","Z48.89","R10.9","N17.9","N18.9","T78.40XA","N52.9","R05.2","I25.10","N13.4","M25.551","M16.9","N20.1","I49.9","L03.211","H90.3","J30.2","R06.7","R05.1","M25.559","Z23.","Z13.89","S90.121A","B35.3","L08.9","Z46.6","E04.1","J43.9","M47.812","M79.652","E16.0","T38.3X5A","Z98.890","Z91.19","E11.22","M87.9","M17.12","Z68.26","S01.112A","H11.32","T14.90XA","H57.12","M62.81"],"date":["2021-02-14","2021-05-07","2021-05-07","2021-05-08","2021-08-12","2021-08-12","2023-05-17","2023-06-25","2022-03-14","2023-05-17","2022-11-23","2022-11-23","2022-11-23","2022-11-23","2023-06-01","2023-06-23","2023-02-22","2023-02-23","2023-03-23","2023-03-23","2023-03-23","2023-03-23","2023-03-23","2023-03-23","2021-02-11","2021-02-11","2023-03-07","2021-02-11","2021-03-03","2021-02-15","2022-08-31","2021-03-31","2021-03-31","2021-05-07","2021-03-29","2021-03-29","2023-02-20","2021-03-29","2023-01-10","2023-05-11","2022-12-12","2022-08-09","2022-11-01","2022-11-01","2022-11-01","2023-02-20","2023-05-11","2023-06-25","2023-06-25","2022-12-01","2023-02-20","2023-02-20","2023-02-20","2023-02-23","2023-02-23","2023-02-23","2023-02-23","2023-02-23","2023-02-23","2021-02-17","2023-06-01","2021-03-18","2022-08-30","2022-05-19","2021-11-15","2023-06-01","2023-08-22","2022-09-06","2023-01-19","2023-06-23","2023-01-10","2023-01-10","2023-02-28","2023-03-05","2022-11-09","2021-01-18","2021-05-07","2021-02-17","2021-02-17","2021-03-03","2022-08-16","2023-02-23","2023-05-17","2021-05-07","2021-07-28","2022-08-15","2021-02-18","2021-05-07","2021-12-23","2022-08-30","2022-11-09","2022-11-09","2022-11-09","2022-11-22","2023-06-25","2022-11-22","2022-12-07","2022-12-07","2022-12-07","2021-03-03","2021-11-29","2021-11-29","2021-11-29","2022-06-20","2022-06-20","2022-06-20","2022-08-10","2022-08-15","2022-08-31","2023-06-01","2023-06-01","2023-03-27","2023-06-25","2023-06-25","2023-06-25","2023-06-25","2023-08-01"],"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":[["","53885001110","ONETOUCH DEL","MIS PLUS 30G","100","Select","Select",""],["","00597015330","JARDIANCE","25 MG","30","Select","Select",""],["","08290328418","INSULIN SYRG","MIS 1ML\/31G","60","Select","Select",""],["","55111064501","OMEPRAZOLE","CAP 40MG","30","Select","Select",""],["","68180063509","ATORVASTATIN","TAB 10MG","30","Select","Select",""],["","16729018201","HYDROCHLOROT","TAB 12.5MG","30","Select","Select",""],["","00006027731","JANUVIA","100 MG","30","Select","Select",""],["","53885027210","ONETOUCH","TES VERIO","100","Select","Select",""],["","29300039805","AMLODIPINE","TAB 10MG","30","Select","Select",""],["","00172572860","FAMOTIDINE","TAB 20MG","30","Select","Select",""],["","59267102504","PFIZER VACC","INJ ADLT RTU","0","Select","Select",""],["","00093310953","AMOXICILLIN","CAP 500MG","30","Select","Select",""],["","45802086802","POLYETH GLYC","POW 3350 NF","476","Select","Select",""],["","00169369619","NOVOLOG MIX","70-30 FLEXPEN 70-30\/ML","3","Select","Select",""],["","00904693126","PEG 3350","POW ","30","Select","Select",""],["","65162003310","APAP\/CODEINE","TAB 300-30MG","12","Select","Select",""],["","00113021771","PAIN RELIEF","TAB 650MG","90","Select","Select",""],["","00280210032","ASPIRIN LOW","TAB 81MG EC","30","Select","Select",""],["","00603188016","LIDOCAINE","5 %","30","Select","Select",""],["","00904674759","IBUPROFEN","TAB 200MG","20","Select","Select",""],["","00173069600","ADVAIR DISKU","AER 250\/50","60","Select","Select",""],["","00487020160","IPRATROPIUM\/","SOL ALBUTER","360","Select","Select",""],["","31722099601","HYDROCO\/APAP","TAB 5-325MG","10","Select","Select",""],["","31722064430","TADALAFIL","TAB 5MG","90","Select","Select",""],["","00597007541","SPIRIVA","CAP HANDIHLR","30","Select","Select",""],["","66993058597","FLUTIC\/SALME","AER 250\/50","60","Select","Select",""],["","50228018001","GABAPENTIN","CAP 300MG","60","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","18","Select","Select",""],["","51660033301","ARTHRTS PAIN","TAB 650MG","60","Select","Select",""],["","08290320550","BD PEN NEEDL","MIS 32GX5\/32","100","Select","Select",""],["","00002879759","HUMALOG MIX","75-25 KWIKPEN 75-25\/ML","12","Select","Select",""],["","31722054301","INDOMETHACIN","CAP 50MG","30","Select","Select",""],["","31722072320","LEVOFLOXACIN","750 MG","5","Select","Select",""],["","59746017310","PREDNISONE","10 MG","42","Select","Select",""],["","00456120130","LINZESS","145 MCG","30","Select","Select",""],["","51660093901","CETIRIZINE","TAB 10MG","30","Select","Select",""],["","50580078324","TYLENOL 8 HR","TAB 650MG","90","Select","Select",""],["","16571020110","DICLOFENAC","TAB 75MG DR","30","Select","Select",""],["","51672129803","KETOCONAZOLE","CRE 0.02","60","Select","Select",""],["","00002823305","INSULIN LISP","INJ PROTAMIN","12","Select","Select",""],["","00904699860","DOCUSATE SOD","CAP 100MG","60","Select","Select",""],["","16729018201","HYDROCHLOROTHIAZIDE","12.5 MG","30","Select","Select",""],["","43547028910","BUPROPION HCL SR","150 MG","60","Select","Select",""],["","00173069700","ADVAIR DISKUS","500-50 MCG","60","Select","Select",""],["","69097084087","IPRATROPIUM-ALBUTEROL","0.5-3MG\/3","360","Select","Select",""],["","00597007541","SPIRIVA HANDIHALER","18 MCG","30","Select","Select",""],["","53885027025","ONETOUCH VERIO TEST STRIP","","50","Select","Select",""],["","29300039805","AMLODIPINE BESYLATE","10 MG","30","Select","Select",""],["","63304082790","ATORVASTATIN CALCIUM","10 MG","30","Select","Select",""],["","00002823305","INSULIN LISPRO PROTAMINE MIX","75-25\/ML","3","Select","Select",""],["","11822041923","ACETAMINOPHEN ER","650 MG","90","Select","Select",""],["","00121092616","PROMETHAZINE VC","5-6.25MG\/5","40","Select","Select",""],["","00406012301","HYDROCODONE-ACETAMINOPHEN","5 MG-325MG","12","Select","Select",""],["","70010016201","LORATADINE","10 MG","30","Select","Select",""],["","00093751831","FLUTICASONE-SALMETEROL","250-50 MCG","60","Select","Select",""],["","66993001968","ALBUTEROL SULFATE HFA","90 MCG","18","Select","Select",""],["","08290320550","NANO","2ND GEN PEN NEEDLE 32GX 5\/32\"","100","Select","Select",""],["","57664037708","TRAMADOL HCL","50 MG","12","Select","Select",""],["","53885004401","ONETOUCH VERIO FLEX METER","","1","Select","Select",""],["","53885026701","ONETOUCH VERIO IQ METER","","1","Select","Select",""],["","62332025118","AZITHROMYCIN","250 MG","6","Select","Select",""],["","42806071401","BENZONATATE","100 MG","30","Select","Select",""],["","51660093901","CETIRIZINE HCL","10 MG","90","Select","Select",""],["","60505257809","ATORVASTATIN TAB","10MG","30","Select","Select",""],["","00597015330","JARDIANCE TAB","25MG","30","Select","Select",""],["","16729018201","HYDROCHLOROT TAB","12.5MG","30","Select","Select",""],["","00006027731","JANUVIA TAB","100MG","30","Select","Select",""],["","55111064505","OMEPRAZOLE CAP","40MG","30","Select","Select",""],["","08290328418","INSULIN SYRG MIS","1ML\/31G","60","Select","Select",""],["","29300039805","AMLODIPINE TAB","10MG","30","Select","Select",""],["","00172572860","FAMOTIDINE TAB","20MG","30","Select","Select",""],["","53885027150","ONETOUCH TES VERIO","","50","Select","Select",""],["","53885001110","ONETOUCH DEL MIS PLUS","30G","100","Select","Select",""],["","59267102504","PFIZER VACC INJ ADLT RTU","","0","Select","Select",""],["","00093310953","AMOXICILLIN CAP","500MG","30","Select","Select",""],["","45802086802","POLYETH GLYC POW","3350 NF","476","Select","Select",""],["","65162003310","APAP\/CODEINE TAB","300-30MG","12","Select","Select",""],["","00280210032","ASPIRIN LOW TAB","81MG EC","30","Select","Select",""],["","00169368512","NOVOLOG MIX INJ","70\/30","20","Select","Select",""],["","00904693126","PEG","3350 POW","30","Select","Select",""],["","00113021771","PAIN RELIEF TAB","650MG","90","Select","Select",""],["","65162079108","LIDOCAINE PAD","5%","30","Select","Select",""],["","31722099601","HYDROCO\/APAP TAB","5-325MG","10","Select","Select",""],["","00904674759","IBUPROFEN TAB","200MG","20","Select","Select",""],["","00169369619","NOVOLOG MIX INJ FLEXPEN","","30","Select","Select",""],["","66993001968","ALBUTEROL AER HFA","","18","Select","Select",""],["","00173069600","ADVAIR DISKU AER","250\/50","60","Select","Select",""],["","66993058597","FLUTIC\/SALME AER","250\/50","60","Select","Select",""],["","00487020160","IPRATROPIUM\/ SOL ALBUTER","","360","Select","Select",""],["","00597007541","SPIRIVA CAP HANDIHLR","","30","Select","Select",""],["","50228018001","GABAPENTIN CAP","300MG","90","Select","Select",""],["","31722064430","TADALAFIL TAB","5MG","90","Select","Select",""],["","16571020110","DICLOFENAC TAB","75MG DR","30","Select","Select",""],["","51660033301","ARTHRTS PAIN TAB","650MG","90","Select","Select",""],["","08290320550","BD PEN NEEDL MIS","32GX4MM","100","Select","Select",""],["","00002879759","HUMALOG MIX INJ","75\/25KWP","12","Select","Select",""],["","31722054301","INDOMETHACIN CAP","50MG","30","Select","Select",""],["","59746017506","PREDNISONE TAB","20MG","10","Select","Select",""],["","31722072320","LEVOFLOXACIN TAB","750MG","5","Select","Select",""],["","50580078324","TYLENOL","8 HR TAB 650MG","90","Select","Select",""],["","51660093901","CETIRIZINE TAB","10MG","30","Select","Select",""],["","00904699860","DOCUSATE SOD CAP","100MG","60","Select","Select",""],["","00456120130","LINZESS CAP","145MCG","90","Select","Select",""],["","51672129803","KETOCONAZOLE CRE","2%","60","Select","Select",""],["","00002823305","INSULIN LISP INJ PROTAMIN","","12","Select","Select",""],["","51660033301","ARTHRITIS PAIN RELIEF","650 MG","90","Select","Select",""],["","68180096412","TIOTROPIUM BROMIDE","18 MCG","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":""}]}]}