{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" ESSEJENEEK","gend":0,"add":"IIDE 332EVA NOS","city":"PORTSMOUTH","state":"VA","zip":"23702-9998","dob":"1974-10-03","age":"","mstatus":"","insh":"70700210*77","cliId":"","pno":"43\/7579125-3","cno":"757\/343-5219","email":"","ename":"","eno":"","pphy":"BEVERLY, VERNIS MD","ppno":"757\/484-2001","pcpadd":"STE A 3800 POPLAR HILL RD","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":23321,"pcpcounty":"","pcpid":"","pcpname":"Adult and Pediatric Medical Associates","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":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F32.9","R17.","R79.89","A03.9","B20.","R19.7","Z21.","B18.1","B15.9","F33.2","S60.222A","R10.9","M25.562","V89.2XXA","Y92.9","Y93.9","Z20.822","F33.9","E87.6","N39.0","J45.909","E66.9","R70.0","A09.","F17.210","Z88.6","Z91.018","Z68.39","Z79.899","Z28.21","K52.9","K76.6","N17.9","I10.","R31.9","F43.10","F14.10","H53.8","R53.1","G47.30","K21.9","B19.10","F19.90","J18.9","R53.83","R74.8","R94.5","R50.81","B34.9","K76.89","F14.20","V62.84","Z59.0","R10.84","R07.9","R61.","R53.81","S62.022A","Z01.812","R93.3","NO DATA","R00.0","R09.02","F14.90","F15.90","F12.90","Z91.14","Z79.82","Z86.19","Z03.818"],"date":["2021-02-20","2021-03-12","2021-02-26","2021-02-26","2022-10-13","2021-02-26","2021-02-26","2022-10-11","2021-03-12","2021-05-05","2021-07-16","2021-07-16","2021-07-16","2021-07-16","2021-07-16","2021-07-16","2022-10-11","2021-07-14","2021-07-30","2021-01-20","2022-10-11","2021-01-23","2021-01-20","2021-01-20","2022-10-11","2021-02-20","2022-10-11","2021-01-20","2021-02-20","2021-01-20","2021-01-21","2021-02-20","2021-02-20","2022-10-11","2021-02-20","2021-02-20","2021-02-20","2021-02-20","2021-02-20","2022-06-22","2022-06-22","2022-10-12","2022-10-12","2022-10-12","2021-01-03","2021-02-25","2021-03-12","2022-10-13","2022-10-13","2021-02-23","2021-01-03","2021-01-03","2021-01-03","2021-01-20","2021-01-23","2021-07-30","2021-07-30","2021-07-30","2021-02-06","2021-02-09","2022-10-11","2022-10-11","2022-10-11","2022-10-11","2022-10-11","2022-10-11","2022-10-11","2022-10-11","2022-10-11","2020-12-11"],"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":[["","31722071290","PANTOPRAZOLE","TAB 20MG","60","Select","Select",""],["","61958250101","BIKTARVY","TAB ","30","Select","Select",""],["","70436001102","BUPROPN","TAB 300MG XL","14","Select","Select",""],["","65162027250","SMZ\/TMP","TAB 800-160","12","Select","Select",""],["","55111028130","LEVOFLOXACIN","TAB 750MG","4","Select","Select",""],["","57896086406","MELATONIN","TAB 3MG","120","Select","Select",""],["","10702001850","OXYCODONE","TAB 5MG","10","Select","Select",""],["","67877019805","AMLODIPINE","TAB 5MG","30","Select","Select",""],["","67877022310","GABAPENTIN","CAP 300MG","180","Select","Select",""],["","00904645780","DOK","CAP 100MG","20","Select","Select",""],["","55111012705","CIPROFLOXACN","TAB 500MG","7","Select","Select",""],["","00093356026","PEG\/NASUL,C","SOL NACL\/POT","1","Select","Select",""],["","68180044501","QUETIAPINE","TAB 25MG","30","Select","Select",""],["","52268001201","SUPREP","SOL PREP KIT","354","Select","Select",""],["","60505015801","BUPROPION","TAB 75MG","30","Select","Select",""],["","13107003234","MIRTAZAPINE","TAB 45MG","30","Select","Select",""],["","49884041301","URSODIOL","TAB 500MG","90","Select","Select",""],["","16714061305","SERTRALINE","TAB 100MG","60","Select","Select",""],["","61958200201","DESCOVY","TAB 200\/25MG","30","Select","Select",""],["","60505265901","TRAZODONE","TAB 300MG","30","Select","Select",""],["","49702022813","TIVICAY","TAB 50MG","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":""}]}]}