{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DONALD  A FELSCH","gend":0,"add":"1345 N GREAT NECK ROAD","city":"VIRGINIA BEACH","state":"VA","zip":"23454-9998","dob":"1964-01-02","age":"","mstatus":"","insh":"20071690*01","cliId":"","pno":7577796976,"cno":7577796976,"email":"","ename":"","eno":"","pphy":"FORTUNE, JENNIFER BROOKE PA","ppno":7574258590,"pcpadd":"1253 NIMMO PKWY STE 110,","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":"23456-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7574225107,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M43.16","M43.06","M25.512","S83.92XA","F31.32","F10.21","L40.0","L91.8","M79.671","M79.672","R60.0","Z01.818","M21.41","F31.9","F41.1","M76.71","M76.72","L60.0","G89.29","M25.551","Z96.643","M79.651","F17.210","Z01.810","Z01.812","M87.859","M17.0","M25.562","S76.112S","Z79.899","M54.6","NO DATA","Z68.28","R76.8","Z68.29","M25.362","M17.12","Z86.010","K63.5","K29.70","I10.","M20.11","M20.12","Z98.890","F31.10","K70.30","J45.20","M67.432","E78.1","E55.9","R73.03","B18.2","J41.0","F17.200","Z12.5","I85.00","K74.60","Z86.19","A04.8","K72.90","E11.42","M19.071","G47.00","M25.662","Z68.30","Z96.652","H25.13","M47.9","M54.5","B19.20","M19.90","F10.10","Z68.31","R21.","L23.9"],"date":["2022-10-24","2021-10-11","2021-11-05","2021-11-30","2022-07-12","2023-07-14","2022-04-25","2022-04-25","2023-06-22","2023-06-28","2023-06-28","2023-06-28","2022-09-09","2023-07-14","2023-07-14","2023-02-28","2023-06-28","2023-02-28","2023-04-09","2023-04-09","2023-04-09","2023-04-09","2023-04-09","2023-06-28","2023-06-28","2021-04-05","2021-04-05","2021-12-22","2021-04-05","2022-09-21","2021-07-08","2023-05-25","2021-10-22","2021-10-20","2021-12-07","2021-10-22","2022-09-21","2022-09-01","2022-04-27","2022-04-27","2023-06-14","2022-11-14","2022-09-21","2022-10-27","2023-06-14","2023-06-14","2023-06-14","2021-02-02","2022-06-27","2022-06-27","2022-06-27","2022-06-27","2022-06-27","2022-06-27","2022-06-27","2022-09-01","2022-09-01","2022-09-01","2022-09-01","2022-09-01","2022-10-07","2022-11-14","2021-06-03","2021-06-03","2021-06-03","2021-12-22","2023-03-24","2023-06-30","2021-08-16","2022-09-21","2022-09-21","2022-09-21","2022-10-24","2023-03-20","2023-03-20"],"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":[["","43547030503","ARIPIPRAZOLE TAB","15MG","90","Select","Select",""],["","70461032103","FLUCLVX QUAD INJ","2021-22","0","Select","Select",""],["","80777027399","MODERNA VAC INJ COVID-","19","0","Select","Select",""],["","70436001002","BUPROPN HCL TAB","150MG XL","30","Select","Select",""],["","45802048678","DOCUSATE SOD CAP","100MG","60","Select","Select",""],["","59310057922","PROAIR HFA AER","","8","Select","Select",""],["","00093317431","ALBUTEROL AER HFA","","8","Select","Select",""],["","62332014231","CELECOXIB CAP","200MG","60","Select","Select",""],["","00603188016","LIDOCAINE PAD","5%","30","Select","Select",""],["","58160082652","HAVRIX INJ","1440UNIT","1","Select","Select",""],["","69097084507","CYCLOBENZAPR TAB","5MG","30","Select","Select",""],["","49483000301","BISACODYL TAB","5MG EC","2","Select","Select",""],["","00093220401","METOCLOPRAM TAB","5MG","2","Select","Select",""],["","59779030603","CVS PURELAX POW","","510","Select","Select",""],["","50428042790","MAG CITRATE SOL LEMON","","296","Select","Select",""],["","50428009256","GENTLE LAXAT TAB","5MG EC","2","Select","Select",""],["","50111045001","TRAZODONE TAB","150MG","30","Select","Select",""],["","31722093612","OMEGA-","3-ACID CAP 1GM","120","Select","Select",""],["","00093026292","FLUOCINONIDE CRE","0.05%","60","Select","Select",""],["","57664050658","METOPROL TAR TAB","25MG","60","Select","Select",""],["","00310737020","BUDES\/FORMOT AER","160-4.5","10","Select","Select",""],["","62332054760","CLOBETASOL CRE","0.05%","60","Select","Select",""],["","68180072103","AMLODIPINE TAB","10MG","30","Select","Select",""],["","51991029301","OXCARBAZEPIN TAB","300MG","30","Select","Select",""],["","00186037020","SYMBICORT AER","160-4.5","10","Select","Select",""],["","50428025689","STOMACH RELF CHW","262MG","120","Select","Select",""],["","45802041926","AMMONIUM LAC LOT","12%","400","Select","Select",""],["","65649030302","XIFAXAN TAB","550MG","60","Select","Select",""],["","00121087316","LACTULOSE SOL","10GM\/15","900","Select","Select",""],["","10702001801","OXYCODONE TAB","5MG","21","Select","Select",""],["","50428047796","SKIN TRTMENT LOT","12%","400","Select","Select",""],["","42858010401","OXYCOD\/APAP TAB","10-325MG","21","Select","Select",""],["","00172392670","DIAZEPAM TAB","5MG","14","Select","Select",""],["","57237016199","OMEPRAZOLE CAP","20MG","28","Select","Select",""],["","23155076701","TETRACYCLINE CAP","500MG","56","Select","Select",""],["","00299391702","CETAPHIL CRE MOISTURE","","170","Select","Select",""],["","00093031401","KETOROLAC TAB","10MG","16","Select","Select",""],["","50111033301","METRONIDAZOL TAB","250MG","56","Select","Select",""],["","42808020209","UREA CRE","45%","255","Select","Select",""],["","45802049383","AMMONIUM LAC CRE","12%","280","Select","Select",""],["","10702000310","PROMETHAZINE TAB","25MG","30","Select","Select",""],["","57896092110","ASPIRIN TAB","325MG EC","60","Select","Select",""],["","59267030402","PFIZER BIVAL INJ BA","4\/BA5","0","Select","Select",""],["","19515080852","FLULAVAL QUA INJ","2022-23","0","Select","Select",""],["","29300014701","QUETIAPINE TAB","25MG","60","Select","Select",""],["","62332014231","CELECOXIB","200 MG","60","Select","Select",""],["","29300014701","QUETIAPINE FUMARATE","25 MG","60","Select","Select",""],["","64980029101","PERPHENAZINE","4 MG","60","Select","Select",""],["","65649030302","XIFAXAN","550 MG","60","Select","Select",""],["","42858010401","OXYCODONE-ACETAMINOPHEN","10MG-325MG","21","Select","Select",""],["","51991029301","OXCARBAZEPINE","300 MG","180","Select","Select",""],["","00603188016","LIDOCAINE","5 %","30","Select","Select",""],["","50111045001","TRAZODONE HCL","150 MG","30","Select","Select",""],["","45802048678","DOCUSATE SODIUM","100 MG","60","Select","Select",""],["","70436005901","BUPROPION HCL SR","150 MG","90","Select","Select",""],["","57896092110","ASPIRIN EC","325 MG","60","Select","Select",""],["","21922000101","FLUOCINONIDE","0.05 %","60","Select","Select",""],["","10702000310","PROMETHAZINE HCL","25 MG","30","Select","Select",""],["","57664050658","METOPROLOL TARTRATE","25 MG","60","Select","Select",""],["","00536340401","NICOTINE GUM","2 MG","100","Select","Select",""],["","00115180401","HYDROXYZINE PAMOATE","50 MG","30","Select","Select",""],["","76385012350","METHOCARBAMOL","500 MG","21","Select","Select",""],["","68382003516","VENLAFAXINE HCL ER","75 MG","90","Select","Select",""],["","45802000403","HYDROCORTISONE","2.5 %","28","Select","Select",""],["","53746010901","HYDROCODONE-ACETAMINOPHEN","5 MG-325MG","21","Select","Select",""],["","68180072103","AMLODIPINE BESYLATE","10 MG","30","Select","Select",""],["","69097084507","CYCLOBENZAPRINE HCL","5 MG","30","Select","Select",""],["","14613033972","QUICKVUE AT-HOME COVID-","19 TEST","8","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":""}]}]}