{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LUCIO HERNANDEZ JUAREZ","gend":0,"add":"PO BOX 924","city":"ACCOMAC","state":"VA","zip":"23301-9998","dob":"1976-06-11","age":"","mstatus":"","insh":"2463362*01","cliId":"","pno":7577105498,"cno":7577105498,"email":"","ename":"","eno":"","pphy":"FUSSELL, LUCAS ALLEN NP","ppno":7577877374,"pcpadd":"20306 BADGER LANE,","pcpcity":"ONLEY","pcpstate":"VA","pcpzip":"23418-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7577874513,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N18.6","R51.9","Z12.11","K63.89","K63.5","K64.8","I12.0","E78.00","Z88.8","Z79.899","Z99.2","Z86.16","Z87.891","Z01.818","I08.1","Z11.52","J81.0","Z91.15","R07.89","R07.9","D12.2","Z01.810","E78.5","R73.03","I15.1","E78.2","D63.1","N05.1","M41.9","M54.2","R16.0","R10.13","H10.45","Z23."],"date":["2023-08-01","2022-09-21","2022-10-06","2022-10-06","2022-10-06","2022-10-06","2022-12-22","2022-10-06","2022-10-06","2022-10-06","2022-12-22","2022-12-22","2022-10-06","2022-12-22","2022-04-05","2022-07-20","2022-04-04","2022-04-04","2022-04-04","2022-04-05","2022-10-06","2022-12-22","2022-12-22","2023-04-04","2023-04-04","2023-04-04","2023-04-04","2023-04-04","2023-04-04","2023-04-04","2023-04-04","2023-04-04","2023-04-04","2023-04-04"],"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":[["","69097081312","GABAPENTIN","100 MG","30","Select","Select",""],["","49230064551","VELPHORO","500MG IRON","120","Select","Select",""],["","68180082147","LANTHANUM","CHW 1000MG","90","Select","Select",""],["","68180072103","AMLODIPINE","TAB 10MG","30","Select","Select",""],["","30768019995","VITAMIN D3","CAP 1000UNIT","3","Select","Select",""],["","72888003605","CARVEDILOL","12.5 MG","180","Select","Select",""],["","53746010901","HYDROCO\/APAP","TAB 5-325MG","20","Select","Select",""],["","60258016001","RENA-VITE","0.8 MG","30","Select","Select",""],["","70377000415","SIMVASTATIN","40 MG","90","Select","Select",""],["","69315011710","FUROSEMIDE","40 MG","90","Select","Select",""],["","00378064010","PREDNISONE","5 MG","90","Select","Select",""],["","43386009019","GAVILYTE-G","SOL ","4000","Select","Select",""],["","65862092127","SEVELAMER","TAB 800MG","180","Select","Select",""],["","64380088404","CINACALCET","TAB 60MG","60","Select","Select",""],["","68180082147","LANTHANUM CARBONATE","1000 MG","120","Select","Select",""],["","58602000739","OLOPATADINE HCL","0.2 %","2.5","Select","Select",""],["","72888001205","CYCLOBENZAPRINE HCL","5 MG","30","Select","Select",""],["","64380088404","CINACALCET HCL","60 MG","60","Select","Select",""],["","68180072103","AMLODIPINE BESYLATE","10 MG","90","Select","Select",""],["","62332002991","LOSARTAN POTASSIUM","100 MG","90","Select","Select",""],["","68180072103","AMLODIPINE TAB","10MG","90","Select","Select",""],["","69097081312","GABAPENTIN CAP","100MG","30","Select","Select",""],["","76385011150","CARVEDILOL TAB","6.25MG","60","Select","Select",""],["","53746010901","HYDROCO\/APAP TAB","5-325MG","20","Select","Select",""],["","49230064551","VELPHORO CHW","500MG","120","Select","Select",""],["","68180082147","LANTHANUM CHW","1000MG","90","Select","Select",""],["","70377000415","SIMVASTATIN TAB","40MG","30","Select","Select",""],["","00378064010","PREDNISONE TAB","5MG","90","Select","Select",""],["","60258016001","RENA-VITE TAB","","30","Select","Select",""],["","75834002001","VITAMIN D","3 1250 MCG","3","Select","Select",""],["","43547040211","FUROSEMIDE TAB","40MG","30","Select","Select",""],["","65862092127","SEVELAMER TAB","800MG","180","Select","Select",""],["","43386009019","GAVILYTE-G SOL","","4000","Select","Select",""],["","64380088404","CINACALCET TAB","60MG","60","Select","Select",""],["","59922063101","AURYXIA","210MG IRON","180","Select","Select",""],["","00310110530","LOKELMA","5 G","17","Select","Select",""],["","53436008430","VELTASSA","8.4 GRAM","16","Select","Select",""],["","59651000305","OMEPRAZOLE","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":""}]}]}