{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"   ADNAMASMOSSES N","gend":1,"add":"ELPAM N 84232 TPA TC ","city":"NEWPORT NEWS","state":"VA","zip":"23608-9998","dob":"1987-11-02","age":"","mstatus":"","insh":"1817110*97","cliId":"","pno":"18\/7574957-3","cno":"757\/813-7594","email":"","ename":"","eno":"","pphy":"ELLIOTT, JOY DO","ppno":"757\/594-3800","pcpadd":"10510 JEFFERSON AVENUE STE A","pcpcity":"NEWPORT NEWS","pcpstate":"VA","pcpzip":23601,"pcpcounty":"","pcpid":"","pcpname":"Riverside Brentwood Medical Center","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N93.9","Z32.02","F90.2","F41.9","F32.9","M25.511","M77.11","G89.29","W19.XXXA","Y93.44","S43.401A","S53.401A","M75.81","F41.8","V62.84","Z20.828","N39.0","R81.","R10.9","M62.838","M62.89","E11.9","I10.","T76.21XA","Z53.21","U07.1","Z86.69","Z79.1","Z79.52","Z79.51","Z79.899","Z20.822","F31.4","F19.20","F60.3","J11.1","R10.2","R10.30","F29.","I49.9","G43.519","R07.89","E66.01","Z68.41","M54.2","Z30.2","N30.90","E86.0","R51."],"date":["2021-09-24","2020-03-04","2021-12-01","2021-12-01","2021-12-09","2021-12-16","2021-12-16","2021-11-16","2021-11-16","2021-11-16","2021-11-16","2021-11-16","2021-12-16","2020-09-07","2020-09-07","2020-09-07","2020-09-12","2021-01-07","2021-01-07","2021-01-07","2021-01-07","2021-10-20","2021-07-06","2021-11-13","2021-11-13","2021-12-28","2021-12-28","2021-12-28","2021-12-28","2021-12-28","2021-12-28","2021-12-28","2021-12-09","2021-12-09","2021-12-09","2021-12-28","2021-09-24","2021-07-06","2020-09-08","2020-09-08","2020-12-17","2020-12-17","2021-09-24","2021-09-24","2021-04-07","2021-09-24","2020-07-14","2020-07-14","2020-07-14"],"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":[["","68382005005","MELOXICAM","TAB 7.5MG","20","Select","Select",""],["","00310620530","FARXIGA","TAB 5MG","30","Select","Select",""],["","69543042510","NAPROXEN","TAB 375MG","30","Select","Select",""],["","11917014296","ALCOHOL","PAD ","200","Select","Select",""],["","53885024510","ONETOUCH","TES ULTRA","200","Select","Select",""],["","70010075401","METHOCARBAM","TAB 500MG","40","Select","Select",""],["","00378718505","METFORMIN","TAB 500MG","30","Select","Select",""],["","68180051303","LISINOPRIL","TAB 5MG","30","Select","Select",""],["","52817033200","CYCLOBENZAPR","TAB 10MG","15","Select","Select",""],["","13668013701","ESCITALOPRAM","TAB 20MG","30","Select","Select",""],["","00591352530","LIDOCAINE","PAD 0.05","20","Select","Select",""],["","69097052444","DICLOFENAC","GEL 0.01","100","Select","Select",""],["","59267100001","PFIZER","INJ COVID-19","0","Select","Select",""],["","33342009441","RIZATRIPTAN","TAB 10MG ODT","9","Select","Select",""],["","42799011101","ETODOLAC","TAB 400MG","14","Select","Select",""],["","00406055201","OXYCODONE","TAB 5MG","5","Select","Select",""],["","65702071210","ACCU-CHEK","TES GUIDE","200","Select","Select",""],["","00904699880","DOCUSATE","CAP 100MG","30","Select","Select",""],["","64380080807","IBUPROFEN","TAB 600MG","20","Select","Select",""],["","47781019601","OXYCOD\/APAP","TAB 5-325MG","5","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","18","Select","Select",""],["","00078043205","FOCALIN","CAP 20MG","30","Select","Select",""],["","68382091634","METHYLPRED","TAB 4MG","21","Select","Select",""],["","57237007710","ONDANSETRON","TAB 4MG ODT","20","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","58657050016","CODEINE\/GG","SOL 10-100\/5","160","Select","Select",""],["","00228203150","ALPRAZOLAM","TAB 1MG","60","Select","Select",""],["","00677007010","FERROUS","TAB 325MG","60","Select","Select",""],["","00904759080","FEROSUL","TAB 325MG","60","Select","Select",""],["","59762500801","MISOPROSTOL","TAB 200MCG","2","Select","Select",""],["","10370010250","BUPROPN","TAB 300MG XL","30","Select","Select",""],["","68382003616","VENLAFAXINE","CAP 150MG ER","30","Select","Select",""],["","43547030403","ARIPIPRAZOLE","TAB 10MG","30","Select","Select",""],["","00363010412","PAIN","TAB 325MG","30","Select","Select",""],["","10702000350","PROMETHAZINE","TAB 25MG","12","Select","Select",""],["","00093314705","CEPHALEXIN","CAP 500MG","20","Select","Select",""],["","00363023820","STOOL","CAP 100MG","30","Select","Select",""],["","14539067401","HYDROXYZ","CAP 25MG","60","Select","Select",""],["","65862085901","FAMOTIDINE","TAB 20MG","60","Select","Select",""],["","43598075201","BUPROPION","TAB 150MG SR","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":""}]}]}