{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SANDRA GAY","gend":1,"add":"PO BOX 3204","city":"SUFFOLK","state":"VA","zip":"23439-9998","dob":"1962-10-19","age":"","mstatus":"","insh":"20071726*01","cliId":"","pno":7575410399,"cno":7575410399,"email":"","ename":"","eno":"","pphy":"BHOWMIK, NIHAR MD","ppno":7573990701,"pcpadd":"301 GOODE WAY #103,","pcpcity":"PORTSMOUTH","pcpstate":"VA","pcpzip":"23704-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7573993731,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R42.","M54.16","V58.89","X58.XXXD","M54.12","Z98.1","Z79.899","G89.4","NO DATA","M25.519","M25.522","M79.641","M25.579","M54.2","M75.51","M25.559","R07.9","I10.","I65.29","Z68.21","Z23.","K21.9","Z00.00","N28.1","R31.21","Z01.419","Z30.40","D25.9","M25.512","M48.061","S46.012A","X58.XXXA","M47.22","M48.02","M47.812","M54.42","M54.41","G89.29","R26.2","M79.606","M96.1","M51.17","M25.561","J06.9","R03.0","F41.1","M54.10","R07.89","Z20.822"],"date":["2021-04-08","2023-09-20","2022-07-11","2022-07-11","2023-09-20","2023-09-20","2023-09-20","2023-09-20","2023-09-20","2023-09-20","2023-09-20","2023-09-20","2023-09-20","2023-01-16","2023-01-16","2023-09-20","2021-02-03","2022-03-22","2021-02-03","2021-02-03","2021-11-30","2022-10-27","2022-10-27","2021-11-30","2022-03-22","2022-08-17","2023-05-31","2023-05-31","2021-03-19","2021-07-21","2022-01-25","2022-01-25","2022-03-23","2023-09-06","2023-09-06","2023-09-06","2023-09-06","2023-09-06","2021-07-29","2021-10-29","2021-07-15","2022-08-12","2021-03-08","2022-11-08","2022-10-27","2022-10-27","2022-11-08","2022-11-08","2022-11-08"],"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":[["","00555901858","TRI-SPRINTEC","TAB ","28","Select","Select",""],["","70700015010","OMEPRAZOLE","20 MG","30","Select","Select",""],["","31722099601","HYDROCO\/APAP","TAB 5-325MG","120","Select","Select",""],["","50228017705","GABAPENTIN","600 MG","90","Select","Select",""],["","00591352530","LIDOCAINE","5 %","90","Select","Select",""],["","00172392760","DIAZEPAM","10 MG","2","Select","Select",""],["","49035049860","EQ MUCUS ER","TAB 600MG","20","Select","Select",""],["","50111078751","AZITHROMYCIN","250 MG","6","Select","Select",""],["","00456120130","LINZESS","145 MCG","30","Select","Select",""],["","68645056259","IBUPROFEN","TAB 600MG","90","Select","Select",""],["","65162083366","DICLOFENAC","GEL 0.01","100","Select","Select",""],["","68180087673","NORETHINDRON","TAB 0.35MG","28","Select","Select",""],["","00832105415","BACLOFEN","10 MG","90","Select","Select",""],["","68645051554","AMLODIPINE","TAB 5MG","1","Select","Select",""],["","68180087673","NORETHINDRONE","0.35 MG","28","Select","Select",""],["","00406012305","HYDROCODONE-ACETAMINOPHEN","5 MG-325MG","120","Select","Select",""],["","45802006435","TRIAMCINOLONE ACETONIDE","0.1 %","45","Select","Select",""],["","80681017400","VITAMIN D","3 1250 MCG","4","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":""}]}]}