{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LAWRENCE WILE","gend":0,"add":"1340 30TH ST APT 20","city":"NEWPORT NEWS","state":"VA","zip":"23607-9998","dob":"1964-12-19","age":"","mstatus":"","insh":"20057058*01","cliId":"","pno":7577551769,"cno":7577551769,"email":"","ename":"","eno":"","pphy":"PLATAMONE, NICOLAS S DO","ppno":7575943800,"pcpadd":"10510 JEFFERSON AVE SUITE A,","pcpcity":"NEWPORT NEWS","pcpstate":"VA","pcpzip":"23601-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7575943818,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G93.41","J96.21","G40.89","I10.","F51.02","Z63.72","F32.9","NO DATA","D69.49","E56.9","J30.2","H61.029","F17.200","F33.1","F10.27","F41.1","R56.9","E55.9","F10.229","Z20.828","J44.1","G40.209","R41.9","Z87.820","I67.9","F10.10","M79.641","E53.8","Z79.899","J44.9","Z87.891","E78.5","F32.5","Z00.00","Z23.","Z12.5","F17.210","Z72.0","G47.00","Z86.69","R06.02","J18.9","G40.909","Z86.19","B18.2","J43.9","S39.011A","R69.","S82.035A","F10.230","A41.9","E87.1","J96.01","F10.920","T59.811A","N39.0","M19.141","M25.552","M54.42","F10.131","S82.002A","F01.50","F01.51","J44.0","F02.80","F10.220","M48.54XA","Z20.822","R65.20","T78.3XXA","Z91.14","Z66.","Z79.51","R25.1","M25.551","R26.89"],"date":["2021-06-01","2021-06-01","2021-06-01","2023-06-29","2021-06-17","2021-06-01","2022-08-08","2023-07-28","2021-06-01","2021-06-01","2021-06-01","2021-06-01","2022-09-19","2021-06-17","2021-06-17","2021-06-17","2021-12-09","2021-06-17","2021-06-17","2021-10-30","2022-08-03","2022-02-03","2022-01-13","2022-01-13","2022-01-13","2022-08-08","2022-01-13","2022-01-13","2022-05-23","2022-08-08","2022-09-19","2022-08-08","2022-08-08","2022-09-19","2022-09-19","2022-09-19","2022-09-19","2022-08-02","2022-07-07","2023-06-29","2022-07-31","2022-08-03","2022-08-03","2021-08-12","2023-01-27","2021-10-30","2021-10-30","2022-05-22","2022-05-23","2022-05-24","2022-08-03","2022-08-03","2022-08-03","2022-08-02","2022-08-02","2021-02-01","2022-02-14","2023-08-31","2022-04-12","2021-06-01","2022-05-24","2022-05-24","2022-08-03","2022-07-30","2022-07-30","2022-07-30","2022-07-30","2022-07-30","2022-08-03","2022-03-28","2022-05-23","2022-05-23","2022-05-23","2022-05-23","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":[["","68180011507","LEVETIRACETA","TAB 1000MG","60","Select","Select",""],["","00228212750","CLONIDINE","TAB 0.1MG","28","Select","Select",""],["","16729017017","ESCITALOPRAM","TAB 20MG","14","Select","Select",""],["","69315012710","FOLIC ACID","1 MG","30","Select","Select",""],["","31722070290","LOSARTAN POT","TAB 100MG","30","Select","Select",""],["","50111056001","TRAZODONE","TAB 50MG","30","Select","Select",""],["","27241009706","DULOXETINE","CAP 20MG","90","Select","Select",""],["","65862001605","AMOXICILLIN","CAP 250MG","2","Select","Select",""],["","13107005999","APAP\/CODEINE","TAB 300-30MG","30","Select","Select",""],["","47335061930","DRIZALMA","CAP 60MG DR","7","Select","Select",""],["","49281072110","FLUBLOK QUAD","INJ 2021-22","0","Select","Select",""],["","00173071620","ADVAIR HFA","AER 115\/21","12","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","8","Select","Select",""],["","59267100002","PFIZER VACC","INJ COVID-19","0","Select","Select",""],["","50111078810","AZITHROMYCIN","TAB 500MG","2","Select","Select",""],["","59310057922","PROAIR HFA","AER ","8","Select","Select",""],["","00603533932","PREDNISONE","TAB 20MG","21","Select","Select",""],["","68180052001","LISINOP\/HCTZ","TAB 20-25MG","30","Select","Select",""],["","69097052444","DICLOFENAC","GEL 0.01","100","Select","Select",""],["","65162019050","NAPROXEN","TAB 500MG","20","Select","Select",""],["","59746000103","METHYLPRED","TAB 4MG","21","Select","Select",""],["","00904530660","BANOPHEN","CAP 25MG","28","Select","Select",""],["","16571066701","PHENOBARB","TAB 64.8MG","12","Select","Select",""],["","00093342210","CYCLOBENZAPR","TAB 10MG","20","Select","Select",""],["","00597007541","SPIRIVA","CAP HANDIHLR","30","Select","Select",""],["","80681007100","VITAMIN B-12","TAB 100MCG","30","Select","Select",""],["","70377002811","ATORVASTATIN","TAB 20MG","30","Select","Select",""],["","77333071510","PRENATAL","TAB ","30","Select","Select",""],["","68462010530","ONDANSETRON","TAB 4MG","20","Select","Select",""],["","53746054201","POT CHLORIDE","CAP 10MEQ ER","10","Select","Select",""],["","00603188016","LIDOCAINE","PAD 0.05","30","Select","Select",""],["","80681009800","VITAMIN B-1","TAB 100MG","30","Select","Select",""],["","00536589588","NICOTINE TD","DIS 14MG\/24H","28","Select","Select",""],["","31604001281","B1","TAB 100MG","30","Select","Select",""],["","16714047701","AMOX\/K CLAV","TAB 500-125","8","Select","Select",""],["","50268085215","VITAMIN B12","TAB 100MCG","30","Select","Select",""],["","08290236712","LACTINEX","GRA ","30","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","21","Select","Select",""],["","70677005501","SM MUCUS REL","TAB 600MG ER","14","Select","Select",""],["","71351001312","LACTOBACILLU","PAK ","30","Select","Select",""],["","70377002813","ATORVASTATIN CALCIUM","20 MG","30","Select","Select",""],["","43547022406","LEVETIRACETAM","1000 MG","60","Select","Select",""],["","68180052001","LISINOPRIL-HYDROCHLOROTHIAZIDE","20 MG-25MG","30","Select","Select",""],["","00093317431","ALBUTEROL SULFATE HFA","90 MCG","8.5","Select","Select",""],["","27241009706","DULOXETINE HCL","20 MG","90","Select","Select",""],["","50111056001","TRAZODONE HCL","50 MG","30","Select","Select",""],["","43547022406","LEVETIRACETA TAB","1000MG","60","Select","Select",""],["","69315012710","FOLIC ACID TAB","1000MCG","30","Select","Select",""],["","68180052001","LISINOP\/HCTZ TAB","20-25MG","30","Select","Select",""],["","59310057922","PROAIR HFA AER","","8","Select","Select",""],["","00093317431","ALBUTEROL AER HFA","","8","Select","Select",""],["","00173071620","ADVAIR HFA AER","115\/21","12","Select","Select",""],["","50111056001","TRAZODONE TAB","50MG","30","Select","Select",""],["","69097052444","DICLOFENAC GEL","1%","100","Select","Select",""],["","27241009706","DULOXETINE CAP","20MG","90","Select","Select",""],["","59746000103","METHYLPRED TAB","4MG","21","Select","Select",""],["","00904530660","BANOPHEN CAP","25MG","28","Select","Select",""],["","65162019050","NAPROXEN TAB","500MG","20","Select","Select",""],["","16571066701","PHENOBARB TAB","64.8MG","12","Select","Select",""],["","77333071510","PRENATAL TAB","","30","Select","Select",""],["","00093342210","CYCLOBENZAPR TAB","10MG","20","Select","Select",""],["","68462010530","ONDANSETRON TAB","4MG","20","Select","Select",""],["","00603188016","LIDOCAINE PAD","5%","30","Select","Select",""],["","00597007541","SPIRIVA CAP HANDIHLR","","30","Select","Select",""],["","70377002811","ATORVASTATIN TAB","20MG","30","Select","Select",""],["","70677004901","SM MUCUS REL TAB","600MG ER","14","Select","Select",""],["","43063081630","VITAMIN B-","1 TAB 100MG","30","Select","Select",""],["","53746054201","POT CHLORIDE CAP","10MEQ ER","10","Select","Select",""],["","00536589588","NICOTINE TD DIS","14MG\/24H","28","Select","Select",""],["","16714047701","AMOX\/K CLAV TAB","500-125","8","Select","Select",""],["","68180012202","CEPHALEXIN CAP","500MG","21","Select","Select",""],["","31604001281","B","1 TAB 100MG","30","Select","Select",""],["","08290236712","LACTINEX GRA","","30","Select","Select",""],["","50268085215","VITAMIN B","12 TAB 100MCG","30","Select","Select",""],["","50111078810","AZITHROMYCIN TAB","500MG","2","Select","Select",""],["","71351001312","LACTOBACILLU PAK","","30","Select","Select",""],["","69097015907","MELOXICAM","15 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":""}]}]}