{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TRENESSA  M KIRBY","gend":1,"add":"861 33RD ST APT A","city":"NEWPORT NEWS","state":"VA","zip":"23607-9998","dob":"1972-01-08","age":"","mstatus":"","insh":"2149299*01","cliId":"","pno":7579985268,"cno":7579985268,"email":"","ename":"","eno":"","pphy":"ANTHONY, ERVIN MD","ppno":8047259191,"pcpadd":"10980 BUCKLEY HALL RD BLDG #5,","pcpcity":"MATHEWS","pcpstate":"VA","pcpzip":"23109-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":8047259120,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z12.11","K63.5","K64.9","D64.9","E11.9","B20.","I10.","E78.5","E66.9","Z68.38","E11.65","R76.12","N18.9","R74.8","Z23.","Z21.","Z12.31","E66.01","Z01.810","Z01.812","R94.31","D12.4","H40.003","H35.033"],"date":["2021-07-27","2021-07-27","2021-07-27","2023-06-27","2023-06-27","2023-06-27","2023-06-27","2023-06-27","2022-11-02","2023-03-27","2021-07-22","2021-07-22","2021-11-23","2022-04-13","2021-11-23","2023-03-27","2023-03-27","2021-06-04","2021-07-09","2021-07-09","2021-07-09","2021-07-27","2022-04-05","2022-04-05"],"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":[["","08290320550","BD PEN NEEDL","MIS 32GX5\/32","150","Select","Select",""],["","61958190101","GENVOYA","150-200-10","30","Select","Select",""],["","68180063609","ATORVASTATIN","TAB 20MG","30","Select","Select",""],["","69238106901","POT CHLORIDE","TAB 20MEQ ER","30","Select","Select",""],["","00597015230","JARDIANCE","10 MG","30","Select","Select",""],["","29300039805","AMLODIPINE","TAB 10MG","90","Select","Select",""],["","31722059101","METOPROL SUC","TAB 100MG ER","30","Select","Select",""],["","11822515660","RA ALCOHOL","PAD SWABS","100","Select","Select",""],["","00088221905","LANTUS SOLOS","INJ 100\/ML","6","Select","Select",""],["","00169406012","VICTOZA","2-PAK 0.6 MG\/0.1","6","Select","Select",""],["","53885000810","ONETOUCH DEL","MIS PLUS 33G","100","Select","Select",""],["","53885024450","ONETOUCH","TES ULTRA","100","Select","Select",""],["","73070010315","INSULIN ASPA","INJ FLEXPEN","15","Select","Select",""],["","00169633910","NOVOLOG","INJ FLEXPEN","15","Select","Select",""],["","16729018201","HYDROCHLOROT","TAB 12.5MG","30","Select","Select",""],["","08489831510","PEN NEEDLES","MIS 32GX4MM","150","Select","Select",""],["","80777028299","MODERNA BIVA","INJ BA4\/BA5","0","Select","Select",""],["","11534016501","FOLIC ACID","1 MG","30","Select","Select",""],["","00904759080","FEROSUL","TAB 325MG","30","Select","Select",""],["","58160089052","FLUARIX QUAD","INJ 2022-23","0","Select","Select",""],["","08290320550","NANO","2ND GEN PEN NEEDLE 32GX 5\/32\"","150","Select","Select",""],["","00088221905","LANTUS SOLOSTAR","100\/ML (3)","12","Select","Select",""],["","53885000810","ONETOUCH DELICA PLUS LANCET","33 GAUGE","100","Select","Select",""],["","69238106901","POTASSIUM CHLORIDE","20 MEQ","90","Select","Select",""],["","31722059001","METOPROLOL SUCCINATE","50 MG","30","Select","Select",""],["","00228282011","HYDROCHLOROTHIAZIDE","12.5 MG","90","Select","Select",""],["","60505258009","ATORVASTATIN CALCIUM","40 MG","30","Select","Select",""],["","53885024510","ONETOUCH ULTRA TEST STRIP","","100","Select","Select",""],["","29300039805","AMLODIPINE BESYLATE","10 MG","30","Select","Select",""],["","08290320550","BD PEN NEEDL MIS","32GX5\/32","150","Select","Select",""],["","61958190101","GENVOYA TAB","","30","Select","Select",""],["","68180063609","ATORVASTATIN TAB","20MG","30","Select","Select",""],["","69238106901","POT CHLORIDE TAB","20MEQ ER","30","Select","Select",""],["","00597015230","JARDIANCE TAB","10MG","30","Select","Select",""],["","29300039805","AMLODIPINE TAB","10MG","90","Select","Select",""],["","73070010315","INSULIN ASPA INJ FLEXPEN","","15","Select","Select",""],["","31722059101","METOPROL SUC TAB","100MG ER","30","Select","Select",""],["","00169406013","VICTOZA INJ","18MG\/3ML","9","Select","Select",""],["","00088221905","LANTUS SOLOS INJ","100\/ML","12","Select","Select",""],["","00169633910","NOVOLOG INJ FLEXPEN","","15","Select","Select",""],["","11822515660","RA ALCOHOL PAD SWABS","","100","Select","Select",""],["","53885024450","ONETOUCH TES ULTRA","","100","Select","Select",""],["","53885000810","ONETOUCH DEL MIS PLUS","33G","100","Select","Select",""],["","08489831510","PEN NEEDLES MIS","32GX4MM","150","Select","Select",""],["","16729018201","HYDROCHLOROT TAB","12.5MG","30","Select","Select",""],["","58160089052","FLUARIX QUAD INJ","2022-23","0","Select","Select",""],["","80777028299","MODERNA BIVA INJ BA","4\/BA5","0","Select","Select",""],["","00904759080","FEROSUL TAB","325MG","30","Select","Select",""],["","11534016501","FOLIC ACID TAB","1MG","30","Select","Select",""],["","00005200010","PREVNAR","20 0.5 ML","1","Select","Select",""],["","58160082311","SHINGRIX","50 MCG\/0.5","1","Select","Select",""],["","27808015801","ROSUVASTATIN CALCIUM","40 MG","90","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":""}]}]}