{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ENNIROCSKCIH ","gend":1,"add":"SLOHCIN 015B TPA TS NO","city":"NORFOLK","state":"VA","zip":"23510-9998","dob":"1991-11-16","age":"","mstatus":"","insh":"3071110*84","cliId":"","pno":"83\/7579796-9","cno":"","email":"","ename":"","eno":"","pphy":"DONALDSON, NICOLE MD","ppno":"757\/227-6866","pcpadd":"SUITE 504 301 RIVERVIEW AVENUE","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23510,"pcpcounty":"","pcpid":"","pcpname":"Fort Norfolk Plaza Primary Care","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":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I48.0","K50.019","R11.2","T83.32XA","R10.9","F12.90","R87.610","R87.810","F32.1","R10.13","K31.84","K50.00","L02.31","L73.2","L72.0","L91.0","N90.7","R10.84","R93.3","Z01.818","N39.0","E86.0","F43.21","K62.1","K63.89","K64.8","K59.00","D48.5","K60.3","R07.9","Z20.828","Z01.812","Z11.59","Z01.419","Z12.79","F41.1","R93.9","K63.5","K31.89","K66.0","N85.2","NO DATA","L30.9","G47.00","K62.89","L90.5","I10.","Z80.0","M70.61","M70.62","M25.552","Z86.79","L72.3","F12.10","G89.29","K21.9","N83.201","Z80.9","Z82.49","Z83.3","Z86.718","Z87.891","Z79.899","Z91.013","N83.299","K21.0","Z48.02","Z13.1","Z13.220","Z13.29","N87.0","Z32.02","Z20.822","R07.89","J20.9","N89.8","S31.809A","R52.","J02.9","R05.9","M51.37","F41.9","Z20.2","L70.9","M75.52","R10.817","Z98.890","F32.9","R87.612"],"date":["2022-02-01","2020-05-03","2022-03-01","2020-05-13","2020-05-03","2021-01-24","2020-07-10","2020-07-10","2022-10-04","2021-01-24","2021-03-22","2021-03-22","2021-04-05","2022-10-10","2020-02-17","2020-02-17","2020-02-17","2020-05-03","2020-07-09","2020-07-07","2020-07-20","2020-07-20","2020-08-18","2020-02-20","2020-02-20","2020-02-20","2020-02-20","2020-06-30","2022-05-27","2020-03-05","2021-05-30","2020-07-07","2020-07-07","2022-06-17","2021-06-11","2022-10-04","2020-05-08","2020-02-20","2020-02-20","2020-05-13","2020-05-13","2020-07-09","2020-10-06","2022-09-22","2021-07-30","2021-07-30","2022-02-24","2022-02-24","2021-12-06","2021-12-06","2021-04-22","2022-03-01","2021-07-27","2020-05-01","2020-05-01","2022-05-27","2020-05-01","2020-05-01","2022-05-27","2022-05-27","2020-05-01","2022-05-27","2022-05-27","2022-05-27","2020-05-03","2020-05-03","2020-07-13","2020-09-10","2020-09-10","2020-09-10","2021-07-26","2021-07-26","2022-02-01","2019-10-24","2019-10-24","2019-05-15","2022-03-10","2022-03-10","2022-03-01","2022-02-01","2022-01-28","2022-05-27","2022-06-17","2022-08-02","2022-07-19","2022-03-01","2022-03-01","2022-09-22","2022-11-04"],"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":{"indx":[false,false],"comment":["",""],"score":["",""]}},{"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":[["","45802086802","POLYETH","POW 3350 NF","238","Select","Select",""],["","00074055402","HUMIRA","INJ 40\/0.4ML","4","Select","Select",""],["","58602070584","ACID","TAB 10MG","28","Select","Select",""],["","63739019861","PEG","POW ","12","Select","Select",""],["","00406055201","OXYCODONE","TAB 5MG","8","Select","Select",""],["","","GABAPENTIN","CAP 100MG","","Select","Select",""],["","","METOCLOPRAM","TAB 10MG","","Select","Select",""],["","60505265401","TRAZODONE","TAB 100MG","60","Select","Select",""],["","62175011843","OMEPRAZOLE","CAP 20MG","180","Select","Select",""],["","","DICLOFENAC","TAB 75MG DR","","Select","Select",""],["","","TRIAMCINOLON","CRE 0.001","","Select","Select",""],["","13107003134","MIRTAZAPINE","TAB 15MG","30","Select","Select",""],["","68462048619","CLINDAMY\/BEN","GEL 1-5%","25","Select","Select",""],["","54092010001","MESALAMINE","TAB 1.2GM","60","Select","Select",""],["","00143980305","DOXYCYCL","CAP 100MG","14","Select","Select",""],["","","PROMETHAZINE","TAB 25MG","","Select","Select",""],["","45802058084","SCOPOLAMINE","DIS 1MG\/3DAY","10","Select","Select",""],["","00093031401","KETOROLAC","TAB 10MG","15","Select","Select",""],["","59746012106","MECLIZINE","TAB 25MG","30","Select","Select",""],["","","VALACYCLOVIR","TAB 1GM","","Select","Select",""],["","54092019112","PENTASA","CAP 500MG CR","180","Select","Select",""],["","66424039901","STOOL","CAP 100MG","7","Select","Select",""],["","00904645760","DOK","CAP 100MG","7","Select","Select",""],["","57237007710","ONDANSETRON","TAB 4MG ODT","12","Select","Select",""],["","65162062711","TRAMADOL","TAB 50MG","60","Select","Select",""],["","","SPIRONOLACT","TAB 100MG","","Select","Select",""],["","13668048450","MINOCYCLINE","CAP 100MG","60","Select","Select",""],["","50111033402","METRONIDAZOL","TAB 500MG","4","Select","Select",""],["","65862085901","FAMOTIDINE","TAB 20MG","28","Select","Select",""],["","","CEPHALEXIN","CAP 500MG","","Select","Select",""],["","","GAVILYTE-G","SOL ","","Select","Select",""],["","","OXYCOD\/APAP","TAB 5-325MG","","Select","Select",""],["","","COLACE","CAP 100MG","","Select","Select",""],["","","AMOX\/K","TAB 875-125","","Select","Select",""],["","","BUDESONIDE","CAP 3MG DR","","Select","Select",""],["","","GAVILYTE-C","SOL ","","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","60","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","18","Select","Select",""],["","64380071306","BENZONATATE","CAP 200MG","15","Select","Select",""],["","00536252525","CAPSAICIN","CRE 0.00025","120","Select","Select",""],["","11523723404","MIRALAX","POW 3350 NF","510","Select","Select",""],["","67618031001","SENOKOT","TAB 8.6-50MG","30","Select","Select",""],["","00363030603","SMOOTH","POW ","510","Select","Select",""],["","00173068220","VENTOLIN","AER ","18","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","59762374301","CLINDAMYCIN","GEL 0.01","30","Select","Select",""],["","00406037705","HYDROCO\/APAP","TAB 7.5-300","20","Select","Select",""],["","57237000511","FLUCONAZOLE","TAB 150MG","1","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":""}]}]}