{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"  ECADNACSNAVE N ","gend":1,"add":"OOM DLO 5136DAOR NWOTER","city":"WILLIAMSBURG","state":"VA","zip":"23188-9998","dob":"1990-02-20","age":"","mstatus":"","insh":"5140110*01","cliId":"","pno":"97\/7572459-0","cno":"757\/790-9542","email":"","ename":"","eno":"","pphy":"MAIGI, KIMBERLY D NP","ppno":"757\/345-0011","pcpadd":"7364 RICHMOND ROAD","pcpcity":"WILLIAMSBURG","pcpstate":"VA","pcpzip":23188,"pcpcounty":"","pcpid":"","pcpname":"Riverside Primary Care Norge","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":["J98.8","B34.9","F17.210","I10.","F41.9","F32.9","Z79.899","Z79.3","Z91.013","J02.9","R74.8","E83.19","Z14.8","F10.10","Z81.1","NO DATA","E55.9","G47.9","R79.0","F10.20","F33.2","F12.20","M25.531","T14.8XXA","Z01.419","S52.502A","S52.613A","E87.6","R94.5","S52.522P","S52.602K","W18.39XS","Z71.6","Z01.411","Z32.02","N92.6","Z30.41","V54.12","M25.532","G89.21","R05.","M65.4","J30.2","E53.8","R51.","T46.5X2A","T40.2X2A","F10.129","M79.641","M79.642","R27.8","R10.9","F12.90","R11.2","V58.89","G43.909","E87.5","S09.90XA","B30.9","W01.198A","Z20.828","T39.312A","R45.851","S52.612K","F29.","T88.7XXA","F10.280","Z91.19","S69.82XA","M77.8","G89.29","Z23.","F17.200","G43.009","D57.00","F33.9","R41.82","M79.601"],"date":["2020-08-25","2020-08-25","2022-09-28","2022-09-28","2022-04-04","2021-07-07","2020-08-25","2020-08-25","2022-08-11","2020-08-25","2021-08-02","2021-01-25","2022-02-03","2021-01-25","2021-01-25","2022-02-03","2021-07-29","2021-07-29","2022-02-03","2021-11-02","2021-11-02","2021-11-02","2022-09-28","2022-09-28","2020-06-09","2020-07-06","2020-07-06","2021-07-02","2020-10-20","2022-02-02","2022-08-11","2021-03-31","2021-03-31","2021-09-09","2021-09-09","2021-09-09","2022-04-04","2020-08-17","2022-08-11","2021-05-18","2020-08-24","2021-12-13","2020-01-09","2020-01-09","2020-05-31","2020-07-21","2020-07-21","2021-06-30","2020-02-26","2020-02-26","2020-02-26","2020-03-23","2020-03-23","2020-03-23","2020-03-23","2021-07-07","2021-07-07","2020-03-21","2020-03-21","2020-03-21","2020-06-28","2021-06-30","2021-06-30","2022-08-11","2020-07-21","2020-07-21","2020-10-21","2020-10-21","2022-02-02","2022-02-02","2022-02-02","2020-05-12","2020-08-24","2021-07-02","2021-07-02","2021-07-02","2021-07-04","2021-07-06"],"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":[["","00378728353","NORETH\/ETHIN","TAB FE 1\/20","28","Select","Select",""],["","68001040100","FLUOXETINE","CAP 40MG","30","Select","Select",""],["","67877019805","AMLODIPINE","TAB 5MG","30","Select","Select",""],["","69452015120","VITAMIN","CAP 50000UNT","4","Select","Select",""],["","16729044316","BUPROPN","TAB 150MG XL","30","Select","Select",""],["","42571016242","AMOX\/K","TAB 875-125","14","Select","Select",""],["","00093314705","CEPHALEXIN","CAP 500MG","28","Select","Select",""],["","11788000110","FOLIC","TAB 1MG","30","Select","Select",""],["","50111056003","TRAZODONE","TAB 50MG","30","Select","Select",""],["","68001019703","ESCITALOPRAM","TAB 20MG","30","Select","Select",""],["","68001036703","POT  CHLORIDE","TAB 10MEQ ER","30","Select","Select",""],["","68462019005","NAPROXEN","TAB 500MG","60","Select","Select",""],["","80777027399","MODERNA","INJ COVID-19","0","Select","Select",""],["","23155050110","HYDROXYZ","TAB 25MG","20","Select","Select",""],["","50102022823","TARINA","TAB 1\/20 EQ","28","Select","Select",""],["","69452014420","BENZONATATE","CAP 200MG","21","Select","Select",""],["","45802091939","CETIRIZINE","TAB 10MG","30","Select","Select",""],["","00555902858","JUNEL","TAB 1.5\/30","28","Select","Select",""],["","61314062810","POLYMYXIN","SOL TRIMETHP","10","Select","Select",""],["","68001016200","PROMETHAZINE","TAB 25MG","8","Select","Select",""],["","17478007035","ERYTHROMYCIN","OIN OP","4","Select","Select",""],["","00406012305","HYDROCO\/APAP","TAB 5-325MG","28","Select","Select",""],["","00185067501","ETODOLAC","TAB 400MG","30","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","18","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":""}]}]}