{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MARY  S SPADAFORA","gend":1,"add":"2521 CENTERVILLE TPKE","city":"CHESAPEAKE","state":"VA","zip":"23322-9998","dob":"1970-10-10","age":"","mstatus":"","insh":"2453842*01","cliId":"","pno":7575068986,"cno":7575068986,"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":"M4","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","R11.2","R65.10","E87.5","E78.5","M54.41","M62.838","M77.8","E11.9","F17.210","I51.7","J44.9","Z88.0","M79.602","R10.9","E11.00","L03.115","M79.673","E11.65","Z12.31","E55.9","D25.9","B35.1","T78.40XA","H60.502","R05.9","E10.10","R00.0","E86.0","Z96.41","L50.1","R73.9","E11.8","Z79.4","H10.11","R51.9","R59.0","R09.81","H66.91","R42.","M25.512","Z79.899","M50.322","M54.2","M50.30","I10.","R21.","Z90.721","Z79.51","Z88.2","T85.898A","G44.52","M79.671","Z20.822","J98.01","J06.9","V58.89","L50.9","M54.12","M75.02","E10.9","Z79.01","G89.29","M62.81","R11.10","N17.9","K76.0","D72.829","D25.1","Z79.84","B02.9","Z12.11","T85.614A","E11.43","K31.84","R68.89","H25.13","Z53.21"],"date":["2023-05-30","2022-10-06","2022-06-15","2022-06-15","2023-04-12","2022-06-16","2022-06-16","2022-10-04","2023-01-24","2023-04-12","2022-10-04","2023-04-12","2022-10-06","2022-10-04","2022-06-18","2023-05-01","2022-11-28","2022-11-28","2023-04-12","2023-01-11","2023-01-11","2023-04-12","2023-01-11","2022-09-21","2022-09-21","2022-09-21","2022-11-06","2022-11-07","2022-10-06","2022-10-06","2022-10-10","2022-10-10","2023-06-22","2023-06-22","2022-01-17","2022-01-17","2022-01-17","2022-01-17","2022-05-07","2022-11-07","2023-05-23","2023-05-23","2023-05-30","2023-06-20","2023-06-20","2022-09-21","2022-09-21","2022-09-21","2022-09-21","2022-10-06","2022-11-05","2023-04-12","2023-04-12","2022-09-13","2022-09-13","2022-09-13","2022-09-23","2022-09-23","2022-10-18","2022-10-11","2022-11-06","2022-11-06","2022-02-02","2022-02-02","2022-06-08","2022-06-08","2022-06-08","2022-06-08","2022-06-08","2022-06-08","2022-06-21","2022-10-05","2022-10-06","2022-10-06","2022-10-06","2022-10-18","2023-01-24","2023-05-23"],"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":[["","57599000101","FREESTYLE KIT SENSOR","","2","Select","Select",""],["","57599000200","FREESTYLE MIS READER","","1","Select","Select",""],["","67877041301","METFORMIN TAB","500MG ER","180","Select","Select",""],["","00169210125","NOVOLOG INJ FLEXPEN","","15","Select","Select",""],["","00088221905","LANTUS SOLOS INJ","100\/ML","15","Select","Select",""],["","53885024510","ONETOUCH TES ULTRA","","100","Select","Select",""],["","68645055154","LISINOPRIL TAB","5MG","30","Select","Select",""],["","08290320550","BD PEN NEEDL MIS","32GX5\/32","100","Select","Select",""],["","49281042250","FLUZONE QUAD INJ","2022-23","0","Select","Select",""],["","68180071160","CEFDINIR CAP","300MG","14","Select","Select",""],["","76385010617","KETOTIF FUM DRO","","5","Select","Select",""],["","24208063562","NEO\/POLY\/HC SUS","1% OTIC","10","Select","Select",""],["","53885019401","ONETOUCH KIT VERIO FL","","1","Select","Select",""],["","29300041319","CYCLOBENZAPR TAB","5MG","30","Select","Select",""],["","53885027210","ONETOUCH TES VERIO","","100","Select","Select",""],["","53885092701","ONETOUCH KIT VERIO RE","","1","Select","Select",""],["","65162019011","NAPROXEN TAB","500MG","30","Select","Select",""],["","50383090110","HC\/ACET ACID SOL OTIC","","10","Select","Select",""],["","57237001930","DULOXETINE CAP","60MG","30","Select","Select",""],["","42806054701","VITAMIN D CAP","1.25MG","4","Select","Select",""],["","00093505898","ATORVASTATIN TAB","40MG","30","Select","Select",""],["","00093005805","TRAMADOL HCL TAB","50MG","15","Select","Select",""],["","00172392670","DIAZEPAM TAB","5MG","20","Select","Select",""],["","49483060450","IBUPROFEN TAB","800MG","20","Select","Select",""],["","89152637301","T:SLIM X","2 MIS BASAL6.4","1","Select","Select",""],["","00173069500","ADVAIR DISKU AER","100\/50","60","Select","Select",""],["","00904404073","ASPIRIN CHW","81MG","30","Select","Select",""],["","53885014301","ONETOUCH MIS LANCETS","","100","Select","Select",""],["","89152281705","AUTOSOFT","90 MIS 23\"\/6MM","15","Select","Select",""],["","65862085901","FAMOTIDINE TAB","20MG","60","Select","Select",""],["","65862044930","VALACYCLOVIR TAB","1GM","21","Select","Select",""],["","49502039475","INSULIN GLAR INJ","100U\/ML","15","Select","Select",""],["","69584061150","METHOCARBAM TAB","500MG","40","Select","Select",""],["","53885000810","ONETOUCH DEL MIS PLUS","33G","100","Select","Select",""],["","00169210125","NOVOLOG INJ FLEX REL","","15","Select","Select",""],["","00169210011","NOVOLOG INJ RELION","","30","Select","Select",""],["","66993001968","ALBUTEROL AER HFA","","18","Select","Select",""],["","00054001925","PREDNISONE TAB","50MG","3","Select","Select",""],["","00045020444","ZYRTEC ALLGY CAP","10MG","5","Select","Select",""],["","43598032675","CIPRO\/DEXA SUS","0.3-0.1%","8","Select","Select",""],["","16714008310","HYDROXYZ HCL TAB","50MG","20","Select","Select",""],["","68382005005","MELOXICAM TAB","7.5MG","60","Select","Select",""],["","65162079108","LIDOCAINE PAD","5%","30","Select","Select",""],["","00002614527","BAQSIMI TWO POW","3MG\/DOSE","2","Select","Select",""],["","42806071401","BENZONATATE CAP","100MG","30","Select","Select",""],["","63304069301","CLINDAMYCIN CAP","300MG","30","Select","Select",""],["","42806054701","VITAMIN D","2 1250 MCG","4","Select","Select",""],["","00169210011","NOVOLOG","100\/ML","30","Select","Select",""],["","65862007930","TERBINAFINE HCL","250 MG","30","Select","Select",""],["","68382005105","MELOXICAM","15 MG","30","Select","Select",""],["","42806040021","METHYLPREDNISOLONE","4 MG","21","Select","Select",""],["","00093505898","ATORVASTATIN CALCIUM","40 MG","90","Select","Select",""],["","68645055154","LISINOPRIL","5 MG","90","Select","Select",""],["","70010013901","NAPROXEN","500 MG","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":""}]}]}