{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"WEHTTAMLEZNEW ","gend":0,"add":"NOMHCEEB 813RD XEVIRD T","city":"NEWPORT NEWS","state":"VA","zip":"23608-9998","dob":"1991-06-28","age":"","mstatus":"","insh":"9771210*73","cliId":"","pno":"52\/7571302-6","cno":"757\/256-2031","email":"","ename":"","eno":"","pphy":"GORDON, ASIA D NP","ppno":"757\/930-0091","pcpadd":"12715 WARWICK BLVD SUITE O","pcpcity":"NEWPORT NEWS","pcpstate":"VA","pcpzip":23606,"pcpcounty":"","pcpid":"","pcpname":"Commonwealth Family Practice","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":["F11.20","F41.8","K52.9","F11.90","F12.90","Z79.899","F17.210","E66.9","R10.11","R06.2","Z82.49","M54.41","Z02.83","G89.29","G47.9","F31.30","E66.01","Z68.43","Z86.16","F33.1","F43.10","F13.20","F41.9","G47.00","R03.0","Z20.828","F15.10","R39.198","Z68.42","R79.89","F34.1","R73.03","NO DATA","F15.20","F14.90","E29.1","K08.89","U07.1","F17.200","R51.9","I10.","Z71.6","J06.9","J10.1","Z20.822"],"date":["2022-11-27","2022-03-16","2022-04-10","2022-04-10","2022-04-10","2022-04-10","2022-04-10","2022-04-10","2022-04-10","2022-10-21","2022-10-21","2022-10-21","2022-10-21","2022-10-21","2022-10-21","2022-10-21","2022-10-21","2022-10-21","2022-10-21","2021-04-22","2021-04-22","2021-04-17","2021-04-22","2021-04-05","2020-01-28","2021-01-25","2021-03-22","2020-05-13","2020-11-04","2020-05-13","2021-02-22","2020-11-04","2022-03-16","2021-04-17","2021-04-17","2020-02-04","2021-05-04","2021-09-13","2021-09-13","2021-09-13","2020-01-02","2020-01-02","2021-07-01","2022-11-07","2022-11-07"],"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":[["","67877024901","QUETIAPINE","TAB 50MG","60","Select","Select",""],["","65862052890","VENLAFAXINE","CAP 75MG ER","30","Select","Select",""],["","65162010150","GABAPENTIN","CAP 100MG","60","Select","Select",""],["","00591079501","DICYCLOMINE","TAB 20MG","20","Select","Select",""],["","00172572860","FAMOTIDINE","TAB 20MG","20","Select","Select",""],["","10702000350","PROMETHAZINE","TAB 25MG","20","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","8","Select","Select",""],["","64380079901","OSELTAMIVIR","CAP 75MG","10","Select","Select",""],["","64380080807","IBUPROFEN","TAB 600MG","20","Select","Select",""],["","76204060030","IPRATROPIUM\/","SOL ALBUTER","90","Select","Select",""],["","00472103016","HYDROMET","SYP 5-1.5\/5","120","Select","Select",""],["","12496120803","SUBOXONE","MIS 8-2MG","11","Select","Select",""],["","63459040430","GABITRIL","TAB 4MG","90","Select","Select",""],["","68180098103","LISINOPRIL","TAB 20MG","30","Select","Select",""],["","00115166101","PROPRANOLOL","TAB 40MG","60","Select","Select",""],["","62756022483","TIAGABINE","TAB 4MG","90","Select","Select",""],["","42806071501","BENZONATATE","CAP 200MG","42","Select","Select",""],["","00781185220","AMOX\/K","TAB 875-125","20","Select","Select",""],["","69547035302","NARCAN","SPR ","2","Select","Select",""],["","13107003134","MIRTAZAPINE","TAB 15MG","60","Select","Select",""],["","27241009903","DULOXETINE","CAP 60MG","30","Select","Select",""],["","00069047103","CHANTIX","PAK 0.5& 1MG","53","Select","Select",""],["","00781307370","TESTOST","INJ 100MG\/ML","10","Select","Select",""],["","00904645760","DOK","CAP 100MG","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":""}]}]}