{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TOYA   D BELL","gend":1,"add":"310 GREENFIELD CRES","city":"SUFFOLK","state":"VA","zip":"23434-9998","dob":"1985-11-01","age":"","mstatus":"","insh":"1159408*01","cliId":"","pno":"757\/232-5090","cno":"757\/232-5090","email":"","ename":"","eno":"","pphy":"RAMSEY, KRISTIN DO","ppno":"757\/488-3333","pcpadd":"3925 PORTSMOUTH BLVD","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":23321,"pcpcounty":"","pcpid":137859,"pcpname":"Princess Anne Family Medicine","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/488-0007","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M54.9","G89.29","L30.9","N92.6","U07.1","J12.89","G44.89","F43.29","Z68.41","E55.9","R07.9","I42.9","R06.02","E78.5","G47.33","N91.2","I10.","J18.9","Z20.828","R05.","R50.9","R07.0","NO DATA","E66.01","I50.42","Z68.38","J11.1","M25.579","R10.2","J02.9","R21.","E03.9","G43.909","M54.2","J30.2","H60.90"],"date":["2020-09-09","2020-09-09","2021-03-19","2020-08-20","2020-10-22","2020-09-16","2020-10-05","2020-10-05","2020-10-05","2020-10-22","2020-06-18","2020-10-15","2020-06-18","2020-06-23","2020-10-15","2020-07-14","2020-05-13","2020-09-11","2020-09-11","2020-09-11","2020-09-11","2020-09-11","2020-09-11","2020-10-15","2020-10-15","2020-10-15","2020-02-24","2020-02-24","2020-04-17","2020-02-24","2020-04-17","2020-04-17","2020-05-12","2020-05-12","2021-03-19","2021-03-19"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}},{"a":[]}]},{"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":[]}]},{"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":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","66993060536","ETONOGESTERE ","ETHY EST","1","Select","Select",""],["","11822073997","MUCUS ","120-1200","24","Select","Select",""],["","31722063231","OSELTAMIVIR ","75MG","9","Select","Select",""],["","00054327099","FLUTICASONE ","50MCG","16","Select","Select",""],["","69238110005","DOXYCYCL ","100MG","20","Select","Select",""],["","67877032105","IBUPROFEN ","800MG","30","Select","Select",""],["","71093014005","METHOCARBAM ","500MG","30","Select","Select",""],["","27808006502","PROMETH\/COD ","6.25-10","75","Select","Select",""],["","68180051303","LISINOPRIL ","5MG","30","Select","Select",""],["","66993060536","ETONOGESTREL ","ETHY EST","3","Select","Select",""],["","00093742698","MONTELUKAST ","10MG","30","Select","Select",""],["","76385011050","CARVEDILOL ","3.125MG","60","Select","Select",""],["","59779010112","PAIN ","500MG","100","Select","Select",""],["","69097012403","TOPIRAMATE ","100MG","30","Select","Select",""],["","45802057178","FEXOFENADINE ","180MG","30","Select","Select",""],["","00378180510","LEVOTHYROXIN ","75MCG","30","Select","Select",""],["","00168000615","TRIAMCINOLON ","0.10%","30","Select","Select",""],["","00603459321","METHYLPRED ","4MG","21","Select","Select",""],["","52565009430","CLOBETASOL ","0.05%","30","Select","Select",""],["","69097015807","MELOXICAM ","7.5MG","30","Select","Select",""],["","69452015120","VITAMIN ","50000UNT","12","Select","Select",""],["","00603188016","LIDOCAINE ","5%","30","Select","Select",""],["","00904530660","BANOPHEN ","25MG","90","Select","Select",""],["","69842048490","ACETAMINOPHN ","500MG","60","Select","Select",""],["","00093310705","AMOXICILLIN ","250MG","40","Select","Select",""],["","00116200116","CHLORHEX ","0.12%","473","Select","Select",""],["","59779092312","ALLERGY ","25MG","90","Select","Select",""],["","54569586500","NUVARING ","","1","Select","Select",""],["","43386035701","HYDROCO\/APAP ","7.5-325","6","Select","Select",""],["","45802065078","LORATADINE ","10MG","30","Select","Select",""],["","60505036301","OFLOXACIN ","0.3%OTIC","5","Select","Select",""],["","66993060536","ETONOGESTERE","ETHY EST","1","Select","Select",""],["","69238110005","DOXYCYCL","100MG","20","Select","Select",""],["","11822073997","MUCUS","120-1200","24","Select","Select",""],["","31722063231","OSELTAMIVIR","75MG","9","Select","Select",""],["","27808006502","PROMETH\/COD","6.25-10","75","Select","Select",""],["","00054327099","FLUTICASONE","50MCG","16","Select","Select",""],["","67877032105","IBUPROFEN","800MG","30","Select","Select",""],["","00093742698","MONTELUKAST","10MG","30","Select","Select",""],["","68180051303","LISINOPRIL","5MG","30","Select","Select",""],["","69097012403","TOPIRAMATE","100MG","30","Select","Select",""],["","45802057178","FEXOFENADINE","180MG","30","Select","Select",""],["","00378180510","LEVOTHYROXIN","75MCG","30","Select","Select",""],["","00168000615","TRIAMCINOLON","0.10%","30","Select","Select",""],["","69097015807","MELOXICAM","7.5MG","30","Select","Select",""],["","00603459321","METHYLPRED","4MG","21","Select","Select",""],["","71093014005","METHOCARBAM","500MG","30","Select","Select",""],["","76385011050","CARVEDILOL","3.125MG","60","Select","Select",""],["","69452015120","VITAMIN","50000UNT","12","Select","Select",""],["","00603188016","LIDOCAINE","5%","30","Select","Select",""],["","69842048490","ACETAMINOPHN","500MG","60","Select","Select",""],["","66993060536","ETONOGESTREL","ETHY EST","3","Select","Select",""],["","59779010112","PAIN","500MG","100","Select","Select",""],["","52565009415","CLOBETASOL","0.05%","30","Select","Select",""],["","00904530660","BANOPHEN","25MG","90","Select","Select",""],["","59779092312","ALLERGY","25MG","90","Select","Select",""],["","54569586500","NUVARING","","1","Select","Select",""],["","43386035701","HYDROCO\/APAP","7.5-325","6","Select","Select",""],["","60505036301","OFLOXACIN","0.3%OTIC","5","Select","Select",""],["","45802065078","LORATADINE","10MG","30","Select","Select",""],["","00093310705","AMOXICILLIN","250MG","40","Select","Select",""],["","00116200116","CHLORHEX","0.12%","473","Select","Select",""],["","68180016011","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","64380071207","BENZONATATE ","CAP 100MG","30","Select","Select",""],["","00603533932","PREDNISONE ","TAB 20MG","21","Select","Select",""],["","00093227434","AMOX\/K ","TAB 500-125","20","Select","Select",""]]}},{"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":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[[["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""]]]},{"t":"Mini-Cog","q":[{"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":""}]}]}