{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ANNETTE  D ST CLAIR","gend":1,"add":"3902 HILLWOOD ST","city":"PORTSMOUTH","state":"VA","zip":"23703-9998","dob":"1968-12-30","age":"","mstatus":"","insh":"20069106*01","cliId":"","pno":7579170477,"cno":7579170477,"email":"","ename":"","eno":"","pphy":"RAMOLIA, MANSUKHLAL R MD","ppno":7574836401,"pcpadd":"4035 TAYLOR RD #K,","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":"23321-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7576863025,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E11.65","R35.0","Z71.9","E66.9","Z20.828","G43.009","G56.02","A08.4","M54.16","Z95.0","R00.2","S62.525A","V54.12","Z20.822","B34.9","N39.0","R73.9","F17.210","Z88.5","Z91.09","R10.32","U07.1","M47.816","Z68.31","E11.9","Z68.29","R07.9","I10.","R00.1","E78.00","Z68.30","R50.9","R05.9","R09.89","R11.0","R53.83","R53.1","R06.09","Z86.73","Z79.899","Z91.048","R55.","F31.9","F41.9","R11.2","R05.","M25.532","E03.9","J98.8","Z72.0","J06.9","J01.00","H60.501","E13.9","Z79.4","J40.","R07.89","J02.9"],"date":["2021-08-25","2021-02-01","2023-01-24","2023-01-24","2021-09-30","2021-05-23","2022-04-25","2021-09-30","2022-03-08","2022-05-04","2022-05-04","2022-06-10","2022-06-21","2022-09-04","2022-09-08","2022-09-08","2022-09-08","2023-01-26","2023-01-26","2022-09-08","2022-09-08","2023-01-26","2022-02-24","2022-05-04","2023-01-24","2021-10-12","2022-05-04","2022-06-21","2021-11-17","2021-11-17","2021-11-17","2023-01-26","2023-01-26","2023-01-26","2023-07-16","2023-01-26","2023-01-26","2023-01-26","2023-01-26","2023-01-26","2023-01-26","2021-04-08","2021-11-10","2021-07-12","2021-08-22","2021-08-22","2021-08-22","2022-06-21","2023-01-19","2023-01-19","2023-07-16","2023-07-16","2023-07-16","2022-09-04","2022-09-04","2021-08-25","2021-07-11","2023-05-15"],"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":[["","60505257909","ATORVASTATIN TAB","20MG","90","Select","Select",""],["","68180096601","LEVOTHYROXIN TAB","50MCG","90","Select","Select",""],["","00169643810","LEVEMIR INJ FLEXTOUC","","15","Select","Select",""],["","67877056105","METFORMIN TAB","500MG","90","Select","Select",""],["","00054429931","FUROSEMIDE TAB","40MG","30","Select","Select",""],["","00832712311","DIVALPROEX TAB","250MG DR","90","Select","Select",""],["","69238134201","ETODOLAC TAB","400MG","60","Select","Select",""],["","08290320109","BD PEN NEEDL MIS","31GX8MM","100","Select","Select",""],["","31722059001","METOPROL SUC TAB","50MG ER","45","Select","Select",""],["","31722099601","HYDROCO\/APAP TAB","5-325MG","10","Select","Select",""],["","00002879959","HUMALOG KWIK INJ","100\/ML","15","Select","Select",""],["","13107005999","APAP\/CODEINE TAB","300-30MG","15","Select","Select",""],["","53885027025","ONETOUCH TES VERIO","","300","Select","Select",""],["","00069034530","PAXLOVID TAB","300-100","30","Select","Select",""],["","67877021901","CEPHALEXIN CAP","500MG","28","Select","Select",""],["","53885027210","ONETOUCH VERIO TEST STRIP","","300","Select","Select",""],["","43598032675","CIPROFLOXACIN-DEXAMETHASONE","0.3 %-0.1%","7.5","Select","Select",""],["","08290329652","INSULIN SYRINGE","26GX1\/2\"","100","Select","Select",""],["","00832712311","DIVALPROEX SODIUM","250 MG","90","Select","Select",""],["","67877056105","METFORMIN HCL","500 MG","60","Select","Select",""],["","42806071401","BENZONATATE","100 MG","15","Select","Select",""],["","63304082890","ATORVASTATIN CALCIUM","20 MG","90","Select","Select",""],["","08489830910","DROPLET PEN NEEDLE","31 GX5\/16\"","100","Select","Select",""],["","72516003101","METOPROLOL SUCCINATE","50 MG","45","Select","Select",""],["","65862039010","ONDANSETRON ODT","4 MG","10","Select","Select",""],["","00955172901","INSULIN GLARGINE","100\/ML","2","Select","Select",""],["","65862050320","AMOXICILLIN-CLAVULANATE POTASS","875-125 MG","14","Select","Select",""],["","50111078710","AZITHROMYCIN","250 MG","6","Select","Select",""],["","42806040021","METHYLPREDNISOLONE","4 MG","21","Select","Select",""],["","08496271501","EASY TOUCH INSULIN SYRINGE","27GX1\/2\"","90","Select","Select",""],["","08290320109","ULTRA-FINE SHORT PEN NEEDLE","31 GX5\/16\"","100","Select","Select",""],["","00088222033","LANTUS","100\/ML","10","Select","Select",""],["","68180096601","LEVOTHYROXINE SODIUM","50 MCG","90","Select","Select",""],["","00002879959","HUMALOG KWIKPEN U-","100 100\/ML","9","Select","Select",""],["","00054429931","FUROSEMIDE","40 MG","90","Select","Select",""],["","00169643810","LEVEMIR FLEXTOUCH","100\/ML (3)","12","Select","Select",""],["","11877001140","BINAXNOW COVID-","19 AG SELF TEST","8","Select","Select",""],["","59746017306","PREDNISONE","10 MG","10","Select","Select",""],["","68382004101","PROMETHAZINE HCL","25 MG","12","Select","Select",""],["","62135098505","DOXYCYCLINE HYCLATE","100 MG","20","Select","Select",""],["","69452034572","SUMATRIPTAN SUCCINATE","50 MG","9","Select","Select",""],["","60505257909","ATORVASTATIN","TAB 20MG","90","Select","Select",""],["","00169643810","LEVEMIR","INJ FLEXTOUC","15","Select","Select",""],["","68180096601","LEVOTHYROXIN","TAB 50MCG","90","Select","Select",""],["","67877056105","METFORMIN","TAB 500MG","90","Select","Select",""],["","69238134201","ETODOLAC","TAB 400MG","60","Select","Select",""],["","08290320109","BD PEN NEEDL","MIS 31GX8MM","100","Select","Select",""],["","00832712311","DIVALPROEX","TAB 250MG DR","90","Select","Select",""],["","72516003101","METOPROL SUC","TAB 50MG ER","45","Select","Select",""],["","31722099601","HYDROCO\/APAP","TAB 5-325MG","10","Select","Select",""],["","13107005999","APAP\/CODEINE","TAB 300-30MG","15","Select","Select",""],["","67877021901","CEPHALEXIN","CAP 500MG","28","Select","Select",""],["","00002879959","HUMALOG KWIK","INJ 100\/ML","9","Select","Select",""],["","53885027210","ONETOUCH","TES VERIO","300","Select","Select",""],["","00069034530","PAXLOVID","TAB 300-100","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":""}]}]}