{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"  LATSYRCRENROH R ","gend":1,"add":"ETNIAP 754C TPA TS R","city":"NORFOLK","state":"VA","zip":"23505-9998","dob":"1991-01-05","age":"","mstatus":"","insh":"35600210*97","cliId":"","pno":"37\/7574986-5","cno":"757\/735-6894","email":"","ename":"","eno":"","pphy":"BAUMGARTEN, MARGARET MD","ppno":"757\/397-6344","pcpadd":"3640 HIGH STREET SUITE 3B","pcpcity":"PORTSMOUTH","pcpstate":"VA","pcpzip":23707,"pcpcounty":"","pcpid":"","pcpname":"EVMS Portsmouth Family Medicine","plan":"OHP","program":"MEDICAID","lob":"OHCC","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":["F31.81","F41.1","R05.","J30.9","J02.9","Z20.828","F90.0","F41.9","F10.10","Z30.09","Z30.42","F33.9","F32.9","F43.0","F60.9","F90.9","O99.02","Z37.9","Z3A.00","F33.1","R42.","R11.0","F33.3","F12.90","F15.90","R68.83","R11.2","O75.5","Z87.59","V23.7","Z3A.39","Z37.0","F43.23","F12.20","F15.20","Z20.822","R11.10","O71.89","O99.334","F17.210","O99.62","K21.9","Z88.0","Z23.","Z32.02","Z30.431","Z30.430","R68.89","R51.","F34.1","Z38.00","O35.8XX0","O35.2XX0","O35.9XX0","Z3A.29"],"date":["2021-05-11","2021-08-10","2021-05-21","2021-05-21","2021-05-21","2021-05-21","2022-11-08","2022-11-18","2022-10-21","2020-04-21","2020-06-15","2020-11-18","2020-11-18","2020-11-18","2020-11-18","2020-11-18","2022-04-20","2022-04-20","2022-04-20","2022-11-18","2020-09-25","2020-09-25","2020-10-20","2020-10-18","2020-10-18","2021-01-29","2020-12-15","2022-04-20","2022-04-20","2022-04-20","2022-04-20","2022-04-20","2022-11-08","2020-10-20","2020-10-20","2021-01-29","2021-01-29","2022-04-20","2022-04-20","2022-04-20","2022-04-20","2022-04-20","2022-04-20","2022-04-20","2022-06-30","2022-06-30","2022-06-30","2020-05-22","2020-09-25","2021-08-10","2022-04-20","2022-02-09","2022-02-09","2022-02-09","2022-02-09"],"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":[["","64380080807","IBUPROFEN","TAB 600MG","21","Select","Select",""],["","13107007001","AMPHET\/DEXTR","TAB 10MG","60","Select","Select",""],["","57237000511","FLUCONAZOLE","TAB 150MG","1","Select","Select",""],["","00067434730","SLOW","TAB 45MG","30","Select","Select",""],["","65862018601","CLINDAMYCIN","CAP 300MG","21","Select","Select",""],["","00904672040","ACETAMIN","TAB 500MG","30","Select","Select",""],["","00116200116","CHLORHEX","SOL 0.0012","473","Select","Select",""],["","50111064801","FLUOXETINE","CAP 20MG","30","Select","Select",""],["","60505265301","TRAZODONE","TAB 50MG","30","Select","Select",""],["","68180031909","BUPROPN","TAB 150MG XL","90","Select","Select",""],["","67877024201","QUETIAPINE","TAB 25MG","30","Select","Select",""],["","00093005401","BUSPIRONE","TAB 10MG","270","Select","Select",""],["","42806071401","BENZONATATE","CAP 100MG","42","Select","Select",""],["","00009470913","DEPO-SQ","INJ 104","1","Select","Select",""],["","65862001205","SERTRALINE","TAB 50MG","90","Select","Select",""],["","00115165901","PROPRANOLOL","TAB 10MG","90","Select","Select",""],["","43547028910","BUPROPION","TAB 150MG SR","90","Select","Select",""],["","13668021730","ARIPIPRAZOLE","TAB 5MG","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":""}]}]}