{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DAVITA DOUGLAS","gend":1,"add":"1544 E FAIRFAX DR APT C","city":"VIRGINIA BEACH","state":"VA","zip":"23453-9998","dob":"1990-05-04","age":"","mstatus":"","insh":"4378067*01","cliId":"","pno":7577141643,"cno":7577141643,"email":"","ename":"","eno":"","pphy":"ASUNCION, CHRISTOPHER W MD","ppno":7577055265,"pcpadd":"828 HEALTHY WAY","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":"23462-9998","pcpcounty":"","pcpid":"","pcpname":"Mid-Atlantic Family Medicine","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7579622884,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["NO DATA","D51.9","R26.9","E87.6","R29.898","Z98.1","R20.0","G61.0","R56.9","Z87.891","E66.3","I42.8","I50.23","Z86.69","B34.9","R35.0","N30.00","S05.01XA","S05.02XA","H10.89","J40.","R53.1","R29.2","D64.9","E66.9","S01.512A","I50.22","G83.4","J45.909","Z88.0","Z79.899","Z98.84","Z68.28","Z88.1","M21.372","F41.9","I50.20","I10.","B37.3","M54.17","M54.5","R11.0","H16.223","J06.9","Z11.52","R50.9","Z20.822","R93.1","G62.9","R00.0","Z00.00","K76.0","D70.9","E55.9","R29.6","F17.210","R33.9","L29.8","T40.2X5A","R15.9","M62.838","Z91.81","M25.551","M25.552","Z09.","R00.2","R79.89","E83.42","I50.9","N39.9","N76.89","F34.1","H61.002","Z68.29","J02.9","M94.8X9","H60.12","M54.2","Z01.810"],"date":["2023-04-21","2022-11-23","2022-12-19","2023-02-15","2023-01-05","2022-12-30","2022-12-04","2023-03-16","2023-03-16","2023-04-02","2022-05-09","2023-03-06","2023-01-05","2023-01-05","2021-11-23","2021-11-23","2021-11-23","2022-03-18","2022-03-18","2022-03-18","2022-11-14","2022-12-30","2022-11-30","2023-04-02","2023-04-02","2022-12-30","2023-03-06","2023-01-17","2023-04-02","2022-12-30","2022-12-30","2023-04-02","2022-12-30","2022-12-30","2022-12-30","2023-01-17","2023-03-06","2023-03-06","2021-07-21","2022-01-18","2021-07-21","2023-03-06","2022-03-21","2022-11-09","2022-11-09","2022-11-28","2022-11-28","2023-01-17","2023-02-15","2023-03-06","2021-04-14","2022-11-29","2022-11-29","2022-11-29","2022-11-29","2022-11-29","2022-11-29","2022-11-29","2022-11-29","2022-11-29","2022-11-29","2022-12-07","2022-12-07","2022-12-07","2023-03-06","2023-03-06","2022-12-07","2022-12-07","2023-04-02","2021-01-20","2021-01-20","2021-01-20","2023-04-02","2023-04-02","2023-04-02","2023-04-02","2023-04-02","2023-04-02","2023-04-21"],"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":[["","57237000430","FLUCONAZOLE","100 MG","10","Select","Select",""],["","00143992801","CIPROFLOXACN","TAB 500MG","10","Select","Select",""],["","00172392670","DIAZEPAM","TAB 5MG","30","Select","Select",""],["","10702000350","PROMETHAZINE","TAB 25MG","60","Select","Select",""],["","00527163210","TRIAMT\/HCTZ","CAP 37.5-25","90","Select","Select",""],["","65162062750","TRAMADOL HCL","50 MG","15","Select","Select",""],["","51224010150","PHENTERMINE","TAB 37.5MG","30","Select","Select",""],["","00406051201","OXYCOD\/APAP","TAB 5-325MG","20","Select","Select",""],["","69238126601","OSELTAMIVIR","CAP 75MG","10","Select","Select",""],["","65862042005","SMZ\/TMP DS","TAB 800-160","14","Select","Select",""],["","60432046400","LIDOCAINE","SOL 2% VISC","200","Select","Select",""],["","42806071501","BENZONATATE","CAP 200MG","30","Select","Select",""],["","69097015807","MELOXICAM","TAB 7.5MG","14","Select","Select",""],["","68682029905","LOTEPREDNOL","SUS 0.005","5","Select","Select",""],["","24208029905","LOTEMAX","SUS 0.005","5","Select","Select",""],["","00406055201","OXYCODONE","TAB 5MG","60","Select","Select",""],["","24208091055","ERYTHROMYCIN","OIN 5MG\/GM","4","Select","Select",""],["","57896010410","ACETAMINOPHE","TAB 325MG","180","Select","Select",""],["","41167005840","ASPERCREME","PAD LIDO 4%","30","Select","Select",""],["","59746017710","CYCLOBENZAPR","TAB 10MG","90","Select","Select",""],["","16714008311","HYDROXYZ HCL","TAB 50MG","180","Select","Select",""],["","00121077504","GG\/CODEINE","SOL 100-10\/5","118","Select","Select",""],["","67877022310","GABAPENTIN","CAP 300MG","60","Select","Select",""],["","00093216568","NALOXONE HCL","SPR 4MG","4","Select","Select",""],["","00093005401","BUSPIRONE","TAB 10MG","60","Select","Select",""],["","00904530680","BANOPHEN","CAP 25MG","60","Select","Select",""],["","42806040021","METHYLPRED","TAB 4MG","21","Select","Select",""],["","00591544243","PREDNISONE","PAK 10MG","48","Select","Select",""],["","80681016800","VITAMIN D3","TAB 25MCG","150","Select","Select",""],["","00378561505","LEVETIRACETA","TAB 500MG","60","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","8","Select","Select",""],["","16571020211","DICLOFENAC","TAB 50MG DR","14","Select","Select",""],["","00406051205","OXYCODONE-ACETAMINOPHEN","5 MG-325MG","60","Select","Select",""],["","69097067905","PREGABALIN","75 MG","90","Select","Select",""],["","00093005401","BUSPIRONE HCL","10 MG","60","Select","Select",""],["","31722053705","LEVETIRACETAM","500 MG","60","Select","Select",""],["","45963070911","METOPROLOL SUCCINATE","25 MG","90","Select","Select",""],["","00310621030","FARXIGA","10 MG","30","Select","Select",""],["","55513080060","CORLANOR","5 MG","60","Select","Select",""],["","65862020199","LOSARTAN POTASSIUM","25 MG","30","Select","Select",""],["","00143992801","CIPROFLOXACIN HCL","500 MG","20","Select","Select",""],["","00078065920","ENTRESTO","24 MG-26MG","60","Select","Select",""],["","52817033200","CYCLOBENZAPRINE HCL","10 MG","90","Select","Select",""],["","00781618667","CIPROFLOXACIN-DEXAMETHASONE","0.3 %-0.1%","7.5","Select","Select",""],["","53489014310","SPIRONOLACTONE","25 MG","30","Select","Select",""],["","00781207410","TRIAMTERENE-HYDROCHLOROTHIAZID","37.5-25 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":""}]}]}