{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"NOEL STORMER","gend":1,"add":"11574 OCCOHANOCK RD.                                        ","city":"EXMORE                        ","state":"VA","zip":"23350-9998","dob":"1988-06-24","age":"","mstatus":"","insh":3168019,"cliId":"","pno":7573008485,"cno":"","email":"","ename":"","eno":"","pphy":"SNYDER, JOHN W                                              ","ppno":7573165901,"pcpadd":"9524 Hospital Ave                                           ,                                                            ","pcpcity":"Nassawadox                    ","pcpstate":"VA","pcpzip":23413,"pcpcounty":"","pcpid":"","pcpname":"RIVERSIDE EASTERN SHORE PHYSICIANS AND SURGEONS","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"TIDEWATER","aligned":"","ano":"","add2":"11574 OCCOHANOCK RD.                                        ","add3":"","madd1":"11574 OCCOHANOCK RD.                                        ","madd2":"                                                            ","madd3":"","mcity":"EXMORE                        ","mstate":"VA","mzip":"23350-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["H92.02","H93.12","M26.622","Z20.828","J32.2","J32.0","J32.1","J32.3","R42","R55","R06.02","U07.1","J12.82","J96.00","J96.01","I26.99","Z68.42","H93.19","E66.01","Z71.6","Z87.891","R00.0","R91.8","J18.1","Z79.01","Z86.16","Z87.01","Z99.81","E66.9","Z23","J31.0","J32.9","H66.93","L30.9","F41.9","R06.2","G56.03","M25.531","M25.532","Z86.711","J30.1","J30.89","J30.81","J30.9","H10.45","R06.00","I51.89","R03.0","S81.802A","G56.01","Z88.1","G47.30","G47.19","G47.419"],"date":["2020-06-03","2020-06-03","2020-06-03","2021-04-12","2021-04-15","2021-04-15","2021-04-15","2021-04-15","2021-04-21","2021-04-23","2021-04-22","2021-07-30","2021-04-29","2021-04-29","2021-04-22","2022-02-21","2022-02-21","2021-04-22","2022-02-21","2021-04-22","2022-07-29","2021-04-23","2021-04-26","2021-04-27","2022-01-17","2022-07-29","2021-05-28","2021-05-28","2022-01-31","2022-06-07","2021-12-15","2022-02-07","2022-02-04","2022-02-04","2022-02-04","2022-01-31","2022-01-17","2022-01-17","2022-01-17","2022-07-29","2022-02-07","2022-02-07","2022-02-04","2022-02-04","2022-02-07","2022-02-08","2022-02-09","2022-02-21","2022-06-07","2022-07-29","2022-07-29","2022-11-15","2022-11-15","2022-11-15"],"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":[["","50458057930","XARELTO","TAB 20MG","30","Select","Select",""],["","57664037708","TRAMADOL","TAB 50MG","12","Select","Select",""],["","50111078710","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","59762371709","TRIAZOLAM","TAB 0.125MG","4","Select","Select",""],["","59746017310","PREDNISONE","TAB 10MG","20","Select","Select",""],["","00143924920","AMOX\/K","TAB 875-125","28","Select","Select",""],["","68645056354","IBUPROFEN","TAB 800MG","30","Select","Select",""],["","00781261305","AMOXICILLIN","CAP 500MG","21","Select","Select",""],["","31722094101","HYDROCO\/APAP","TAB 5-325MG","10","Select","Select",""],["","63304069205","CLINDAMYCIN","CAP 150MG","40","Select","Select",""],["","61314064511","NEO\/POLY\/HC","SUS 1% OTIC","20","Select","Select",""],["","00781214501","AMPICILLIN","CAP 500MG","40","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":""}]}]}