{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ANTONIO EVANS","gend":0,"add":"242 W 28TH STREET APT 1","city":"NORFOLK","state":"VA","zip":"23504-9998","dob":"1961-08-19","age":"","mstatus":"","insh":"20048898*01","cliId":"","pno":7574500756,"cno":7574500756,"email":"","ename":"","eno":"","pphy":"BONEY, ARON MD","ppno":7572782240,"pcpadd":"155 KINGSLEY LN STE 400,","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":"23505-9998","pcpcounty":"","pcpid":"","pcpname":"Depaul Medical Associates","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7574896469,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F10.20","J30.2","L50.9","M51.36","F11.90","F43.21","N17.9","E87.6","E83.51","E87.2","R40.0","E87.1","I95.9","V58.89","G92.","N30.00","N40.1","I25.10","G89.4","I10.","E11.9","D53.9","N13.8","Z79.4","I25.118","N52.9","T81.42XA","Z91.198","Z91.199","E11.42","M20.42","R26.89","Z87.898","R33.8","R39.9","M20.11","M20.12","M20.41","S93.401A","L97.521","M25.571","M79.672","R06.02","R23.1","F17.210","Z98.890","I25.83","R07.9","I50.43","I25.119","R94.39","R41.82","Z01.818","T81.31XA","Z76.0","L08.89","I12.9","NO DATA","R33.9","F17.218","Z23.","Z00.00","E11.65","E08.42","Z68.24","I50.22","F11.20","E11.22","T40.2X5A","I65.23","M10.062","R40.4","F11.229","Z68.26","G90.09","M20.10","M20.40","E11.21","Z68.23","F17.200","E78.2","I11.0","F10.10","J43.9","I25.5","I44.7","R94.31","M19.90","Z86.19","Z95.5","I50.9","R77.8","K21.9","M70.22","L90.5","M79.671","E88.81","R60.9","M21.612","M05.79","T81.41XA","M25.531","M25.521","I73.89","Z88.8","M25.422","E11.621","I35.1","K80.20","R11.2","Z11.4","E78.00","Z71.89","E78.5","K86.89","N52.01","M10.9","R10.30","T83.9XXA","F41.1","M79.641","M19.041","M79.89"],"date":["2021-03-23","2021-03-23","2021-10-19","2023-07-25","2023-01-19","2021-01-15","2021-04-16","2023-04-11","2021-04-11","2021-04-13","2021-04-13","2021-04-16","2021-04-13","2022-11-23","2021-04-16","2021-04-15","2023-05-09","2023-04-06","2021-04-15","2023-07-25","2023-04-05","2022-12-20","2021-04-15","2023-07-25","2022-11-09","2022-12-20","2023-01-25","2023-04-26","2023-01-25","2023-04-26","2023-04-26","2021-04-16","2021-10-07","2021-07-07","2021-10-07","2022-05-23","2023-04-26","2022-05-23","2022-12-02","2022-12-02","2022-12-02","2022-12-02","2022-12-23","2022-12-20","2023-07-25","2023-01-19","2023-01-19","2022-12-23","2022-12-21","2022-12-21","2022-12-23","2021-04-11","2022-11-09","2023-01-11","2023-01-11","2023-03-08","2021-04-13","2023-05-09","2023-05-09","2021-06-09","2022-08-17","2022-08-17","2022-01-17","2022-08-17","2023-01-19","2023-07-25","2021-04-11","2021-04-11","2021-04-11","2022-12-20","2021-04-11","2021-04-11","2021-04-11","2021-11-30","2022-05-19","2022-05-19","2022-05-19","2023-07-25","2022-08-17","2022-11-09","2022-12-20","2023-04-06","2022-12-20","2022-12-20","2022-12-20","2022-12-20","2022-12-20","2022-12-20","2022-12-20","2022-12-20","2023-04-06","2022-12-20","2023-05-09","2022-05-08","2023-03-08","2023-03-08","2021-02-24","2021-04-15","2021-08-17","2022-02-17","2022-11-19","2023-03-16","2023-03-16","2022-04-21","2022-05-08","2022-05-08","2022-08-19","2022-12-21","2023-04-05","2023-04-05","2023-07-25","2023-07-25","2023-07-25","2023-04-05","2023-04-05","2023-05-09","2023-03-20","2023-04-06","2023-04-06","2022-10-03","2023-08-31","2023-08-31","2023-08-31"],"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":[["","16729018317","HYDROCHLOROT","TAB 25MG","90","Select","Select",""],["","70000038004","ALL DAY ALLG","TAB 10MG","30","Select","Select",""],["","00904530760","BANOPHEN","50 MG","30","Select","Select",""],["","16729017301","AMITRIPTYLIN","TAB 50MG","30","Select","Select",""],["","10702001801","OXYCODONE","TAB 5MG","30","Select","Select",""],["","00904671772","CETIRIZINE","TAB 10MG","30","Select","Select",""],["","65862055990","PANTOPRAZOLE","TAB 20MG","90","Select","Select",""],["","67877022305","GABAPENTIN","CAP 300MG","180","Select","Select",""],["","67877019805","AMLODIPINE","TAB 5MG","30","Select","Select",""],["","60505258008","ATORVASTATIN","TAB 40MG","30","Select","Select",""],["","68462063945","NITROGLYCERN","SUB 0.4MG","25","Select","Select",""],["","68180098103","LISINOPRIL","20 MG","90","Select","Select",""],["","69367029360","RANOLAZINE","TAB 500MG ER","180","Select","Select",""],["","68462016305","CARVEDILOL","6.25 MG","180","Select","Select",""],["","70010000201","COLCHICINE","TAB 0.6MG","2","Select","Select",""],["","65862059801","TAMSULOSIN","CAP 0.4MG","90","Select","Select",""],["","65862035705","CLOPIDOGREL","75 MG","90","Select","Select",""],["","13668018730","SILDENAFIL","TAB 50MG","20","Select","Select",""],["","70436005901","BUPROPION","TAB 150MG SR","60","Select","Select",""],["","69097068105","PREGABALIN","100 MG","60","Select","Select",""],["","00088221905","LANTUS SOLOS","INJ 100\/ML","15","Select","Select",""],["","69547035302","NARCAN","SPR ","2","Select","Select",""],["","80777027399","MODERNA VAC","INJ COVID-19","0","Select","Select",""],["","00228212750","CLONIDINE","TAB 0.1MG","60","Select","Select",""],["","58160082311","SHINGRIX","INJ 50\/0.5ML","1","Select","Select",""],["","00006432902","VAXNEUVANCE","INJ ","0","Select","Select",""],["","60505476606","APO-VARENICL","TAB 1MG","60","Select","Select",""],["","59651036205","IBUPROFEN","800 MG","30","Select","Select",""],["","69097015812","MELOXICAM","TAB 7.5MG","30","Select","Select",""],["","51672131200","MUPIROCIN","OIN 0.02","22","Select","Select",""],["","67877021905","CEPHALEXIN","CAP 500MG","8","Select","Select",""],["","69618006610","ASPIRIN LOW","TAB 81MG EC","30","Select","Select",""],["","57664037713","TRAMADOL HCL","TAB 50MG","6","Select","Select",""],["","53746020301","OXYCOD\/APAP","TAB 5-325MG","18","Select","Select",""],["","13668010410","ISOSORB MONO","TAB 30MG ER","30","Select","Select",""],["","00173073500","IMITREX","TAB 25MG","1","Select","Select",""],["","31722072320","LEVOFLOXACIN","750 MG","14","Select","Select",""],["","65862018601","CLINDAMYCIN","CAP 300MG","28","Select","Select",""],["","61958100401","RANEXA","TAB 1000MG","60","Select","Select",""],["","00406012305","HYDROCODONE-ACETAMINOPHEN","5 MG-325MG","12","Select","Select",""],["","00406055201","OXYCODONE HCL","5 MG","30","Select","Select",""],["","65862018601","CLINDAMYCIN HCL","300 MG","56","Select","Select",""],["","68382013201","TAMSULOSIN HCL","0.4 MG","14","Select","Select",""],["","68382004001","PROMETHAZINE HCL","12.5 MG","15","Select","Select",""],["","29300039710","AMLODIPINE BESYLATE","5 MG","8","Select","Select",""],["","00591352530","LIDOCAINE","5 %","30","Select","Select",""],["","00591544210","PREDNISONE","10 MG","26","Select","Select",""],["","10702001801","OXYCODONE TAB","5MG","21","Select","Select",""],["","00904530760","BANOPHEN CAP","50MG","30","Select","Select",""],["","00088221905","LANTUS SOLOS INJ","100\/ML","15","Select","Select",""],["","68382009401","CARVEDILOL TAB","12.5MG","180","Select","Select",""],["","69097094605","ATORVASTATIN TAB","40MG","90","Select","Select",""],["","27241012602","RANOLAZINE TAB","1000MG","60","Select","Select",""],["","00228212750","CLONIDINE TAB","0.1MG","60","Select","Select",""],["","67877019805","AMLODIPINE TAB","5MG","90","Select","Select",""],["","69238131309","PREGABALIN CAP","100MG","60","Select","Select",""],["","68462063945","NITROGLYCERN SUB","0.4MG","25","Select","Select",""],["","00006432902","VAXNEUVANCE INJ","","0","Select","Select",""],["","55111019690","CLOPIDOGREL TAB","75MG","90","Select","Select",""],["","58160082311","SHINGRIX INJ","50\/0.5ML","1","Select","Select",""],["","00172208380","HYDROCHLOROT TAB","25MG","30","Select","Select",""],["","60505476606","APO-VARENICL TAB","1MG","60","Select","Select",""],["","65862055990","PANTOPRAZOLE TAB","20MG","30","Select","Select",""],["","65862059801","TAMSULOSIN CAP","0.4MG","90","Select","Select",""],["","67877031901","IBUPROFEN TAB","400MG","28","Select","Select",""],["","69097015812","MELOXICAM TAB","7.5MG","30","Select","Select",""],["","51672131200","MUPIROCIN OIN","2%","22","Select","Select",""],["","70436005901","BUPROPION TAB","150MG SR","60","Select","Select",""],["","57664037713","TRAMADOL HCL TAB","50MG","6","Select","Select",""],["","13668010410","ISOSORB MONO TAB","30MG ER","30","Select","Select",""],["","65862053820","LEVOFLOXACIN TAB","750MG","10","Select","Select",""],["","65862018601","CLINDAMYCIN CAP","300MG","28","Select","Select",""],["","00173073500","IMITREX TAB","25MG","1","Select","Select",""],["","69618006610","ASPIRIN LOW TAB","81MG EC","30","Select","Select",""],["","61958100401","RANEXA TAB","1000MG","60","Select","Select",""],["","53746020301","OXYCOD\/APAP TAB","5-325MG","18","Select","Select",""],["","67877021905","CEPHALEXIN CAP","500MG","8","Select","Select",""],["","29300042110","AMITRIPTYLINE HCL","50 MG","30","Select","Select",""],["","00378165993","SILDENAFIL CITRATE","50 MG","30","Select","Select",""],["","29300046810","CLONIDINE HCL","0.1 MG","180","Select","Select",""],["","43598083205","ATORVASTATIN CALCIUM","40 MG","90","Select","Select",""],["","00378668877","PANTOPRAZOLE SODIUM","20 MG","90","Select","Select",""],["","29300012810","HYDROCHLOROTHIAZIDE","25 MG","90","Select","Select",""],["","43547028910","BUPROPION HCL SR","150 MG","180","Select","Select",""],["","68382009601","HYDROXYCHLOROQUINE SULFATE","200 MG","60","Select","Select",""],["","63304001760","RANOLAZINE ER","500 MG","180","Select","Select",""],["","00406051205","OXYCODONE-ACETAMINOPHEN","5 MG-325MG","28","Select","Select",""],["","43598044774","NICOTINE PATCH","14MG\/24HR","28","Select","Select",""],["","16571020210","DICLOFENAC SODIUM","50 MG","6","Select","Select",""],["","29300034901","ALLOPURINOL","100 MG","90","Select","Select",""],["","00093317431","ALBUTEROL SULFATE HFA","90 MCG","8.5","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":""}]}]}