{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MICHAEL A NYBORG","gend":0,"add":"3840 BATTLEFIELD BLVD S","city":"CHESAPEAKE","state":"VA","zip":"23322-9998","dob":"1977-08-03","age":"","mstatus":"","insh":"20066443*01","cliId":"","pno":7576332758,"cno":7576332758,"email":"","ename":"","eno":"","pphy":"BRAWLEY, JESSICA MD","ppno":7573126267,"pcpadd":"908 EDEN WAY N STE 101,","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":"23320-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7578197185,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["NO DATA","R57.1","N17.9","E87.5","F41.1","F90.0","F41.0","F11.20","F17.210","F14.21","F90.9","M46.1","F12.129","F13.20","Z20.828","F11.23","U07.1","R05.8","F98.8","F19.90","E10.9","F90.2","K21.9","K31.84","M51.36","E10.10","J18.9","E10.43","Z79.4","I12.9","N18.9","D50.9","E78.5","F41.9","E10.22","Z79.899","Z90.49","E13.10","E87.2","E87.6","E87.0","I10.","E87.1","E11.43","Z88.5","Z88.6","Z88.8","E10.65","F31.9","E78.2","E86.0","R57.0","F12.10","Z12.11","E11.9","E78.00","L98.9","F11.21","L82.1","Z71.9"],"date":["2022-07-30","2022-07-30","2022-07-30","2022-07-30","2023-08-31","2022-11-01","2022-11-01","2023-07-10","2022-11-15","2022-11-01","2023-07-13","2023-04-03","2021-11-18","2021-11-18","2021-01-03","2021-07-15","2022-11-16","2022-11-14","2023-08-31","2023-08-31","2023-07-20","2021-07-01","2023-04-27","2023-04-27","2022-04-15","2022-07-27","2022-07-27","2022-07-27","2022-11-15","2022-07-27","2022-07-27","2022-07-27","2022-07-27","2022-07-27","2022-07-27","2022-11-15","2022-11-15","2022-07-29","2022-07-29","2022-07-29","2022-07-29","2023-07-20","2022-07-29","2022-11-15","2022-11-15","2022-11-15","2022-11-15","2023-07-13","2022-11-16","2023-07-13","2022-07-27","2022-07-27","2023-07-10","2023-04-27","2023-04-27","2023-07-20","2023-07-13","2023-09-21","2023-09-13","2023-09-13"],"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":[["","60505265301","TRAZODONE","TAB 50MG","30","Select","Select",""],["","68645055254","LISINOPRIL","10 MG","90","Select","Select",""],["","67877043003","ARIPIPRAZOLE","TAB 2MG","5","Select","Select",""],["","00527551537","AMPHET\/DEXTR","CAP 30MG ER","30","Select","Select",""],["","45963070911","METOPROL SUC","TAB 25MG ER","30","Select","Select",""],["","43598058230","BUPREN\/NALOX","MIS 8-2MG","5","Select","Select",""],["","12496120803","SUBOXONE","8 MG-2 MG","11","Select","Select",""],["","00378668977","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","00093220305","METOCLOPRAM","TAB 10MG","120","Select","Select",""],["","59676058005","JANSSEN VACC","INJ COVID-19","0","Select","Select",""],["","00002879759","HUMALOG MIX","INJ 75\/25KWP","30","Select","Select",""],["","00135019602","NICODERM CQ","DIS 7MG\/24HR","28","Select","Select",""],["","00363124001","NICOTINE","DIS 7MG\/24HR","28","Select","Select",""],["","43598044774","NICOTINE TD","DIS 14MG\/24H","28","Select","Select",""],["","00169183702","NOVOLIN","70-30 70-30\/ML","40","Select","Select",""],["","57599000200","FREESTYLE","MIS READER","1","Select","Select",""],["","43598083205","ATORVASTATIN","TAB 40MG","90","Select","Select",""],["","00002823305","INSULIN LISP","INJ PROTAMIN","30","Select","Select",""],["","08290320550","BD PEN NEEDL","MIS 32GX5\/32","100","Select","Select",""],["","00169183702","NOVOLIN70\/30","INJ RELION","30","Select","Select",""],["","54092039101","ADDERALL XR","CAP 30MG","30","Select","Select",""],["","60219175203","SILDENAFIL","TAB 50MG","30","Select","Select",""],["","45802034405","NICOTINE POL","LOZ 2MG MINT","30","Select","Select",""],["","00172392670","DIAZEPAM","TAB 5MG","2","Select","Select",""],["","00002880359","HUMULIN","INJ 70\/30KWP","12","Select","Select",""],["","11917004813","INSULIN SYRG","MIS 1ML\/31G","10","Select","Select",""],["","16571020150","DICLOFENAC","TAB 75MG DR","60","Select","Select",""],["","68382070718","DOXYCYC MONO","CAP 100MG","10","Select","Select",""],["","42806071401","BENZONATATE","CAP 100MG","15","Select","Select",""],["","11877001140","BINAXNOW COV","KIT HOME TES","2","Select","Select",""],["","00069034530","PAXLOVID","TAB 300-100","30","Select","Select",""],["","00093220301","METOCLOPRAMIDE HCL","10 MG","360","Select","Select",""],["","47781035703","BUPRENORPHINE-NALOXONE","8 MG-2 MG","11","Select","Select",""],["","73070020011","INSULIN ASPART PROT MIX","70-30 70-30\/ML","40","Select","Select",""],["","08290328411","INSULIN SYRINGE","30GX1\/2\"","200","Select","Select",""],["","00169220011","NOVOLOG MIX","70-30 70-30\/ML","40","Select","Select",""],["","00093216568","NALOXONE HCL","4 MG","2","Select","Select",""],["","45963070911","METOPROLOL SUCCINATE","25 MG","90","Select","Select",""],["","42806034401","DEXTROAMPHETAMINE-AMPHETAMINE","20 MG","60","Select","Select",""],["","11877001140","BINAXNOW COVID-","19 AG SELF TEST","2","Select","Select",""],["","31722071390","PANTOPRAZOLE SODIUM","40 MG","90","Select","Select",""],["","00093505898","ATORVASTATIN CALCIUM","40 MG","90","Select","Select",""],["","49035032712","GENTLE LAXATIVE","5 MG","4","Select","Select",""],["","49348089370","CLEARLAX","17 G\/DOSE","238","Select","Select",""],["","00904792760","BISACODYL","5 MG","4","Select","Select",""],["","00093220301","METOCLOPRAM TAB","10MG","120","Select","Select",""],["","45963070911","METOPROL SUC TAB","25MG ER","90","Select","Select",""],["","12496120803","SUBOXONE MIS","8-2MG","4","Select","Select",""],["","00378668977","PANTOPRAZOLE TAB","40MG","90","Select","Select",""],["","00781237101","AMPHET\/DEXTR CAP","30MG ER","30","Select","Select",""],["","43598044774","NICOTINE TD DIS","14MG\/24H","28","Select","Select",""],["","43598058230","BUPREN\/NALOX MIS","8-2MG","5","Select","Select",""],["","68180098003","LISINOPRIL TAB","10MG","90","Select","Select",""],["","45802034405","NICOTINE POL LOZ","2MG MINT","30","Select","Select",""],["","00169300715","NOVOLIN INJ","70\/30 FP","30","Select","Select",""],["","43598083205","ATORVASTATIN TAB","40MG","90","Select","Select",""],["","00002880359","HUMULIN INJ","70\/30KWP","12","Select","Select",""],["","54092039101","ADDERALL XR CAP","30MG","30","Select","Select",""],["","11917004813","INSULIN SYRG MIS","1ML\/31G","60","Select","Select",""],["","67877043003","ARIPIPRAZOLE TAB","2MG","30","Select","Select",""],["","08290320550","BD PEN NEEDL MIS","32GX5\/32","100","Select","Select",""],["","00172392670","DIAZEPAM TAB","5MG","2","Select","Select",""],["","68382070718","DOXYCYC MONO CAP","100MG","10","Select","Select",""],["","11877001140","BINAXNOW COV KIT HOME TES","","2","Select","Select",""],["","16571020150","DICLOFENAC TAB","75MG DR","60","Select","Select",""],["","42806034401","AMPHET\/DEXTR TAB","20MG","60","Select","Select",""],["","42806071401","BENZONATATE CAP","100MG","15","Select","Select",""],["","00069034530","PAXLOVID TAB","300-100","30","Select","Select",""],["","53885027210","ONETOUCH VERIO TEST STRIP","","100","Select","Select",""],["","62088000031","INPEN (FOR HUMALOG)","","1","Select","Select",""],["","52268020101","SUTAB","1.479 G","24","Select","Select",""],["","65862001705","AMOXICILLIN","500 MG","21","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":""}]}]}