{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ZARIYAH   D HINTON","gend":1,"add":"201 E LITTLE CREEK ROAD","city":"NORFOLK","state":"VA","zip":"23505-9998","dob":"2003-06-17","age":"","mstatus":"","insh":"1371426*01","cliId":"","pno":"757\/907-3694","cno":"757\/907-3694","email":"","ename":"","eno":"","pphy":"BURROWS, ADAYNA MD","ppno":"757\/962-8605","pcpadd":"1682 CHURCH STREET","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23504,"pcpcounty":"","pcpid":350008,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/962-8915","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F90.2","K82.8","K80.10","R18.8","E66.01","M79.604","M79.605","F41.9","F33.1","F90.9","K21.9","R10.84","R94.5","M54.5","M62.838","I82.A11","I82.B11","I82.611","K85.10","G43.019","G47.33","F32.9","F32.1","Z68.54","Z91.5","U07.1","D64.9","N92.0","I82.90","R06.02","Z83.79","K85.90","K80.20","R11.0","R10.13","Z45.2","R79.89","I82.621","Z79.01","H18.602","M79.602","Z86.718","R42.","R31.9","J30.2","J45.909","G47.30","K29.70","D62.","T82.868A","R04.0","F33.9","G43.909","F43.10","M54.9","R07.89","M25.511","M25.571","M79.641","S89.91XA","R11.2","R10.9","F11.20","M25.473","R51.","M25.512","R20.2","M54.2"],"date":["2020-02-06","2020-10-25","2020-10-26","2020-10-26","2021-05-21","2020-10-27","2020-10-27","2020-11-20","2020-11-16","2020-11-16","2020-11-20","2020-11-20","2020-11-20","2020-11-02","2020-11-02","2020-11-11","2020-11-11","2020-12-02","2020-11-20","2021-07-12","2020-11-19","2020-11-19","2020-11-20","2020-11-20","2020-11-20","2020-12-04","2020-12-04","2020-12-04","2020-12-04","2021-05-21","2020-10-22","2020-10-25","2020-10-21","2020-10-21","2020-10-25","2020-11-04","2020-10-21","2021-01-19","2021-01-19","2021-05-10","2021-06-16","2021-05-21","2020-01-06","2020-01-06","2020-03-12","2020-03-12","2020-10-21","2020-10-21","2020-10-21","2020-10-21","2020-10-21","2020-10-21","2020-10-21","2020-10-21","2020-10-24","2020-12-02","2021-06-16","2021-06-16","2021-06-16","2021-06-30","2020-10-20","2020-10-21","2020-11-16","2021-01-19","2020-01-08","2021-05-21","2021-05-21","2021-05-21"],"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":[["","59310057922","PROAIR ","","8","Select","Select",""],["","00173071820","FLOVENT ","44MCG","11","Select","Select",""],["","59417010710","VYVANSE ","70MG","30","Select","Select",""],["","45802065078","LORATADINE ","10MG","30","Select","Select",""],["","43386043201","OXYCODONE ","5MG","60","Select","Select",""],["","00781223410","OMEPRAZOLE ","40MG","60","Select","Select",""],["","00093317431","ALBUTEROL ","HFA","8","Select","Select",""],["","10702025350","BUT\/APAP\/CAF ","","30","Select","Select",""],["","00591079401","DICYCLOMINE ","10MG","60","Select","Select",""],["","60505079504","ENOXAPARIN ","100MG\/ML","60","Select","Select",""],["","42192034001","HYOSCYAMINE ","0.125MG","180","Select","Select",""],["","65862018730","ONDANSETRON ","4MG","15","Select","Select",""],["","68382052842","CHOLESTYRAM ","4GM","378","Select","Select",""],["","70010077005","METHOCARBAM ","750MG","28","Select","Select",""],["","43386031214","GAVILAX ","","510","Select","Select",""],["","00536105227","PEG3350 ","","510","Select","Select",""],["","68180035103","SERTRALINE ","25MG","30","Select","Select",""],["","47781030701","NITROFUR ","50MG","32","Select","Select",""],["","75834002001","VITAMIN ","50000UNT","12","Select","Select",""],["","69097094312","GABAPENTIN ","300MG","28","Select","Select",""],["","65162019050","NAPROXEN ","500MG","120","Select","Select",""],["","47781030301","NITROFURANTN ","100MG","14","Select","Select",""],["","47781030301","NITROFURANTN","100MG","14","Select","Select",""],["","59417010710","VYVANSE","70MG","30","Select","Select",""],["","00173071820","FLOVENT","44MCG","11","Select","Select",""],["","45802065078","LORATADINE","10MG","30","Select","Select",""],["","00093317431","ALBUTEROL","HFA","8","Select","Select",""],["","10702025350","BUT\/APAP\/CAF","","30","Select","Select",""],["","43386043201","OXYCODONE","5MG","60","Select","Select",""],["","00781223410","OMEPRAZOLE","40MG","60","Select","Select",""],["","49884046566","CHOLESTYRAM","4GM","378","Select","Select",""],["","00955101010","ENOXAPARIN","100MG\/ML","60","Select","Select",""],["","70010077005","METHOCARBAM","750MG","28","Select","Select",""],["","00591079401","DICYCLOMINE","10MG","60","Select","Select",""],["","42192034001","HYOSCYAMINE","0.125MG","180","Select","Select",""],["","43386031214","GAVILAX","","510","Select","Select",""],["","65862018730","ONDANSETRON","4MG","15","Select","Select",""],["","00536105227","PEG3350","","510","Select","Select",""],["","68180035103","SERTRALINE","25MG","30","Select","Select",""],["","47781030701","NITROFUR","50MG","32","Select","Select",""],["","65162019050","NAPROXEN","500MG","120","Select","Select",""],["","69097094312","GABAPENTIN","300MG","28","Select","Select",""],["","75834002001","VITAMIN","50000UNT","12","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","62756052169","SUMATRIPTAN ","TAB 50MG","9","Select","Select",""],["","00054327099","FLUTICASONE ","SPR 50MCG","16","Select","Select",""],["","80777027399","MODERNA ","INJ COVID-19","0","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":""}]}]}