{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"AMY  E BREEDING","gend":1,"add":"4732 WINDERMERE CT APT 203","city":"VIRGINIA BEACH","state":"VA","zip":"23455-9998","dob":"1974-01-16","age":"","mstatus":"","insh":"20058407*01","cliId":"","pno":7573191769,"cno":7573191769,"email":"","ename":"","eno":"","pphy":"GAGLIONE, MARGARET M MD","ppno":7576446819,"pcpadd":"1405 KEMPSVILLE ROAD,","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":"23320-9998","pcpcounty":"","pcpid":"","pcpname":"COASTAL INTERNAL MEDICINE AND TIDEWATER BARIATRICS","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7576446816,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K08.89","F33.1","F41.1","F41.0","K04.01","K02.9","M47.817","M51.36","M54.5","M17.0","M25.569","Z79.899","M54.16","H04.123","Q14.1","E11.9","H35.82","H25.13"],"date":["2023-04-20","2022-07-12","2022-07-12","2022-07-12","2023-05-20","2023-05-20","2021-05-11","2021-05-11","2021-05-11","2021-05-11","2021-05-11","2021-05-11","2021-05-11","2021-10-04","2021-10-04","2021-10-04","2021-10-04","2021-10-04"],"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":[["","68180072103","AMLODIPINE TAB","10MG","90","Select","Select",""],["","62332008290","VALSART\/HCTZ TAB","320-12.5","30","Select","Select",""],["","13668000901","CITALOPRAM TAB","10MG","270","Select","Select",""],["","42806054701","VITAMIN D CAP","1.25MG","8","Select","Select",""],["","00093506110","HYDROXYZ HCL TAB","25MG","90","Select","Select",""],["","42806008301","BUSPIRONE TAB","7.5MG","60","Select","Select",""],["","68180032009","BUPROPN HCL TAB","300MG XL","90","Select","Select",""],["","70710112701","URSODIOL TAB","250MG","60","Select","Select",""],["","00002143380","TRULICITY INJ","0.75\/0.5","2","Select","Select",""],["","49884012201","LABETALOL TAB","100MG","180","Select","Select",""],["","00093005401","BUSPIRONE HCL","10 MG","30","Select","Select",""],["","00406048410","ACETAMINOPHEN-CODEINE","300MG-30MG","8","Select","Select",""],["","00378623105","CITALOPRAM HBR","10 MG","270","Select","Select",""],["","00002143480","TRULICITY","1.5 MG\/0.5","2","Select","Select",""],["","23155050105","HYDROXYZINE HCL","25 MG","270","Select","Select",""],["","00378632477","VALSARTAN-HYDROCHLOROTHIAZIDE","320-12.5MG","8","Select","Select",""],["","65162062750","TRAMADOL HCL","50 MG","20","Select","Select",""],["","00172392670","DIAZEPAM","5 MG","4","Select","Select",""],["","42806040021","METHYLPREDNISOLONE","4 MG","21","Select","Select",""],["","00406051205","OXYCODONE-ACETAMINOPHEN","5 MG-325MG","18","Select","Select",""],["","55111018015","TIZANIDINE HCL","4 MG","40","Select","Select",""],["","42571016242","AMOXICILLIN-CLAVULANATE POTASS","875-125 MG","20","Select","Select",""],["","00781717612","NALOXONE HCL","4 MG","2","Select","Select",""],["","00406055201","OXYCODONE HCL","5 MG","10","Select","Select",""],["","59651036205","IBUPROFEN","800 MG","20","Select","Select",""],["","49884012201","LABETALOL HCL","100 MG","180","Select","Select",""],["","53746051105","SPIRONOLACTONE","25 MG","90","Select","Select",""],["","68180032002","BUPROPION XL","300 MG","90","Select","Select",""],["","65862018601","CLINDAMYCIN HCL","300 MG","28","Select","Select",""],["","11877001140","BINAXNOW COVID-","19 AG SELF TEST","6","Select","Select",""],["","57237004105","PENICILLIN V POTASSIUM","500 MG","28","Select","Select",""],["","00406012305","HYDROCODONE-ACETAMINOPHEN","5 MG-325MG","12","Select","Select",""],["","29300039810","AMLODIPINE BESYLATE","10 MG","90","Select","Select",""],["","69097067705","PREGABALIN","25 MG","180","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":""}]}]}