{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BETHANN NEVEU","gend":1,"add":"47 CLYDES LN","city":"WINDSOR","state":"VA","zip":"23487-9998","dob":"1975-03-07","age":"","mstatus":"","insh":"1244573*01","cliId":"","pno":"757\/907-1787","cno":"757\/907-1787","email":"","ename":"","eno":"","pphy":"HASHMI, AFREEDA A MD","ppno":"757\/562-2158","pcpadd":"102 FAIRVIEW DRIVE SUITE B","pcpcity":"FRANKLIN","pcpstate":"VA","pcpzip":23851,"pcpcounty":"","pcpid":161374,"pcpname":"Bayview Hospitalist","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/516-8019","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K57.32","R10.32","Z43.2","F43.10","F31.32","G47.00","F90.0","Z63.0","Z62.820","Z62.811","V58.89","K57.30","I10.","F31.70","G40.209","M17.0","M54.42","G89.29","F41.9","E78.00","R73.03","F17.210","K21.9","E66.01","Z68.41","Z71.3","S31.105S","K43.9","L73.2","K91.89","M19.90","F41.8","K43.5","Z93.2","L76.82","Z48.89","K63.5","K64.4","Z86.010","F31.9","Z72.0","F32.9","Z87.891","K65.1","K43.2","Z87.19","L03.90","D12.7","Z79.899","Z23.","Z68.42","Z45.2","N73.9","F90.9","L03.311","H00.012","E78.1","R60.0","K57.92","R60.1","Z20.822","F51.04","F41.1","Z48.815","K57.90","K59.00","K57.20","N17.9","K56.7","Z16.11","R33.9","M79.89","B95.2","B96.20","Z00.00","Z12.39","S31.105D","Z98.0","Z90.49"],"date":["2020-04-20","2020-01-28","2020-04-20","2021-10-27","2021-10-27","2021-10-27","2021-10-27","2021-10-27","2021-10-27","2021-10-27","2021-06-01","2021-03-10","2020-07-08","2020-11-20","2020-07-08","2020-11-20","2020-07-08","2020-07-08","2021-03-10","2020-07-08","2020-11-20","2020-07-08","2020-11-20","2021-07-19","2020-09-28","2020-09-28","2021-07-12","2021-07-12","2021-07-12","2020-02-10","2020-02-10","2020-04-16","2020-07-02","2020-04-20","2020-06-11","2020-06-11","2021-03-10","2021-03-10","2021-03-10","2020-10-30","2021-07-19","2020-04-20","2020-04-20","2020-03-05","2021-07-19","2020-10-30","2021-01-11","2021-03-10","2021-05-17","2021-07-02","2021-07-19","2020-02-05","2020-02-17","2020-11-20","2020-11-20","2020-11-20","2020-11-20","2020-11-20","2020-01-28","2020-02-07","2021-02-26","2021-09-01","2021-09-01","2020-04-24","2020-04-24","2020-01-28","2020-02-03","2020-02-03","2020-02-03","2020-02-03","2020-02-03","2020-02-03","2020-02-03","2020-02-03","2020-07-02","2020-07-02","2021-06-28","2020-04-16","2020-10-30"],"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":[["","00406012301","HYDROCO\/APAP ","5-325MG","30","Select","Select",""],["","00093117701","NEOMYCIN ","500MG","8","Select","Select",""],["","67919002010","ENTEREG ","12MG","1","Select","Select",""],["","29300011316","LAMOTRIGINE ","150MG","60","Select","Select",""],["","16714069301","FLUCONAZOLE ","200MG","5","Select","Select",""],["","67877041920","LINEZOLID ","600MG","10","Select","Select",""],["","50111033402","METRONIDAZOL ","500MG","8","Select","Select",""],["","00172572860","FAMOTIDINE ","20MG","60","Select","Select",""],["","60432003816","GENERLAC ","10GM\/15","473","Select","Select",""],["","58914017014","CARAFATE ","1GM\/10ML","420","Select","Select",""],["","00527143501","METAXALONE ","800MG","90","Select","Select",""],["","10702000201","PROMETHAZINE ","12.5MG","15","Select","Select",""],["","45802088830","OMEPRAZOLE ","20MG","28","Select","Select",""],["","27437010806","ANTARA ","90MG","90","Select","Select",""],["","00143980305","DOXYCYCL ","100MG","20","Select","Select",""],["","63402030430","LATUDA ","40MG","30","Select","Select",""],["","00363089588","NICOTINE ","14MG\/24H","28","Select","Select",""],["","00185067501","ETODOLAC ","400MG","60","Select","Select",""],["","43598029590","PREGABALIN ","150MG","120","Select","Select",""],["","65862018730","ONDANSETRON ","4MG","15","Select","Select",""],["","55111017915","TIZANIDINE ","2MG","30","Select","Select",""],["","00054429731","FUROSEMIDE ","20MG","90","Select","Select",""],["","00093314705","CEPHALEXIN ","500MG","20","Select","Select",""],["","00536106210","STOOL ","100MG","30","Select","Select",""],["","00135047402","NICORETTE ","2MG MINT","100","Select","Select",""],["","63304044330","FENOFIBRATE ","43MG","90","Select","Select",""],["","80681016900","VITAMIN ","25MCG","90","Select","Select",""],["","65862018601","CLINDAMYCIN ","300MG","20","Select","Select",""],["","54092039101","ADDERALL ","30MG","30","Select","Select",""],["","10572010001","PEG-3350 ","ELECTROL","4000","Select","Select",""],["","65862042005","SMZ\/TMP ","800-160","20","Select","Select",""],["","59267100002","PFIZER ","COVID-19","0","Select","Select",""],["","55111012105","ATORVASTATIN ","10MG","90","Select","Select",""],["","00406895401","AMPHET\/DEXTR ","20MG ER","30","Select","Select",""],["","64380080707","IBUPROFEN ","800MG","20","Select","Select",""],["","00116200116","CHLORHEX ","0.12%","473","Select","Select",""],["","60432003816","GENERLAC","10GM\/15","473","Select","Select",""],["","00093117701","NEOMYCIN","500MG","8","Select","Select",""],["","50111033402","METRONIDAZOL","500MG","8","Select","Select",""],["","67919002010","ENTEREG","12MG","1","Select","Select",""],["","10702000201","PROMETHAZINE","12.5MG","15","Select","Select",""],["","00406012301","HYDROCO\/APAP","5-325MG","30","Select","Select",""],["","16714069301","FLUCONAZOLE","200MG","5","Select","Select",""],["","67877041920","LINEZOLID","600MG","10","Select","Select",""],["","58914017014","CARAFATE","1GM\/10ML","420","Select","Select",""],["","00172572960","FAMOTIDINE","40MG","15","Select","Select",""],["","29300011316","LAMOTRIGINE","150MG","60","Select","Select",""],["","63402030430","LATUDA","40MG","30","Select","Select",""],["","00143980305","DOXYCYCL","100MG","20","Select","Select",""],["","65862018730","ONDANSETRON","4MG","15","Select","Select",""],["","00536106210","STOOL","100MG","30","Select","Select",""],["","00185067501","ETODOLAC","400MG","60","Select","Select",""],["","00527143501","METAXALONE","800MG","90","Select","Select",""],["","63304044330","FENOFIBRATE","43MG","90","Select","Select",""],["","55111017915","TIZANIDINE","2MG","30","Select","Select",""],["","27437010806","ANTARA","90MG","90","Select","Select",""],["","00363053278","NICOTINE","4MG MINT","100","Select","Select",""],["","00054429731","FUROSEMIDE","20MG","90","Select","Select",""],["","00135047402","NICORETTE","2MG MINT","100","Select","Select",""],["","43598029590","PREGABALIN","150MG","120","Select","Select",""],["","10572010001","PEG-3350","ELECTROL","4000","Select","Select",""],["","68382050010","OMEPRAZOLE","40MG","90","Select","Select",""],["","00093314705","CEPHALEXIN","500MG","20","Select","Select",""],["","65862042005","SMZ\/TMP","800-160","20","Select","Select",""],["","54092038701","ADDERALL","20MG","30","Select","Select",""],["","00406895401","AMPHET\/DEXTR","20MG ER","30","Select","Select",""],["","59267100002","PFIZER","COVID-19","0","Select","Select",""],["","80681016900","VITAMIN","25MCG","90","Select","Select",""],["","55111012105","ATORVASTATIN","10MG","90","Select","Select",""],["","65862018601","CLINDAMYCIN","300MG","20","Select","Select",""],["","64380080707","IBUPROFEN","800MG","20","Select","Select",""],["","00116200116","CHLORHEX","0.12%","473","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":[[["Yes","Select","","","","","Select","",""],["Yes","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":""}]}]}