{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ERIN   L WHITE","gend":1,"add":"4437 CHELSEA ST APT 202","city":"VIRGINIA BEACH","state":"VA","zip":"23455-9998","dob":"1985-07-16","age":"","mstatus":"","insh":"1600305*01","cliId":"","pno":"757\/470-1587","cno":"757\/470-1587","email":"","ename":"","eno":"","pphy":"SINGSON, FLORISA S MD","ppno":"757\/518-8810","pcpadd":"STE B 4501 N WITCHDUCK RD","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23455,"pcpcounty":"","pcpid":132034,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"757\/803-0258","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/518-8825","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R07.81","R05.","F17.210","S52.031A","O82.","Z20.822","O09.522","Z32.01","Z3A.18","Z11.59","K43.9","Z09.","J20.9","L30.9","F90.9","E03.9","Z83.3","Z82.3","Z82.49","Z88.5","S52.021A","S52.031K","K08.89","O99.333","O34.211","K42.9","K43.6","G89.18","O26.891","R10.31","Z3A.01","R10.2","R10.30","Z3A.11","K02.9","O99.331","F41.8","J01.90","S52.021K","T84.111A","O12.05","R14.0","L02.211","J06.9","B97.89","S29.019A","Z3A.39","Z37.0","Z40.02","Z32.2","F11.20","Z30.2","Z79.899","O86.01","J45.901"],"date":["2020-02-04","2020-02-04","2021-08-23","2020-07-17","2021-05-28","2021-08-23","2021-01-06","2021-01-06","2021-01-06","2020-07-14","2021-06-11","2021-06-11","2020-02-12","2020-01-23","2020-02-04","2020-02-04","2020-02-04","2020-02-04","2020-02-04","2020-11-10","2020-07-06","2020-08-21","2020-11-10","2021-05-26","2021-05-28","2021-07-05","2021-07-08","2021-05-29","2020-11-10","2020-10-12","2020-10-12","2020-10-08","2020-10-08","2020-11-16","2020-11-10","2020-11-10","2020-11-16","2020-11-16","2020-08-21","2020-08-21","2021-06-05","2021-06-05","2021-06-05","2020-02-03","2020-02-03","2020-02-03","2021-05-28","2021-05-28","2021-05-28","2021-05-28","2021-11-15","2021-05-28","2021-05-28","2021-06-05","2021-08-23"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",null,"","","",""]}},{"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":[["","65862056090","PANTOPRAZOLE ","40MG","30","Select","Select",""],["","00591544210","PREDNISONE ","10MG","30","Select","Select",""],["","00781808926","AZITHROMYCIN ","250MG","6","Select","Select",""],["","64380071206","BENZONATATE ","100MG","30","Select","Select",""],["","65862053750","LEVOFLOXACIN ","500MG","10","Select","Select",""],["","68382003616","VENLAFAXINE ","150MG ER","30","Select","Select",""],["","00406055201","OXYCODONE ","5MG","28","Select","Select",""],["","00406324301","HYDROMORPHON ","2MG","12","Select","Select",""],["","65862018601","CLINDAMYCIN ","300MG","14","Select","Select",""],["","27808003502","HYDROCO\/APAP ","5-325MG","24","Select","Select",""],["","00363051908","PAIN ","500MG\/RR","90","Select","Select",""],["","60505082901","FLUTICASONE ","50MCG","16","Select","Select",""],["","80681000900","VITAMIN ","50MCG","100","Select","Select",""],["","00904672059","ACETAMIN ","500MG","90","Select","Select",""],["","64380080707","IBUPROFEN ","800MG","60","Select","Select",""],["","00406051205","OXYCOD\/APAP ","5-325MG","15","Select","Select",""],["","00363023820","STOOL ","100MG","40","Select","Select",""],["","57237004105","PENICILLN ","500MG","28","Select","Select",""],["","57237002801","AMOXICILLIN ","500MG","30","Select","Select",""],["","61314062810","POLYMYXIN ","TRIMETHP","10","Select","Select",""],["","65862085901","FAMOTIDINE ","20MG","60","Select","Select",""],["","69543034030","VIRT-PN ","","90","Select","Select",""],["","10782010130","VITAMEDMD ","ONE RX","90","Select","Select",""],["","65862078330","ESOMEPRA ","20MG DR","30","Select","Select",""],["","10702000350","PROMETHAZINE ","25MG","30","Select","Select",""],["","69097014260","ALBUTEROL ","HFA","7","Select","Select",""],["","45802065087","LORATADINE ","10MG","30","Select","Select",""],["","31722072690","MONTELUKAST ","10MG","30","Select","Select",""],["","68180012202","CEPHALEXIN ","500MG","28","Select","Select",""],["","00085113204","PROVENTIL ","HFA","7","Select","Select",""],["","00173072020","FLOVENT ","220MCG","12","Select","Select",""],["","65162027250","SMZ\/TMP ","800-160","14","Select","Select",""],["","00173068220","VENTOLIN ","","18","Select","Select",""],["","65862056090","PANTOPRAZOLE","40MG","30","Select","Select",""],["","00781808926","AZITHROMYCIN","250MG","6","Select","Select",""],["","64380071206","BENZONATATE","100MG","30","Select","Select",""],["","68382003616","VENLAFAXINE","150MG ER","30","Select","Select",""],["","00591544210","PREDNISONE","10MG","30","Select","Select",""],["","65862053750","LEVOFLOXACIN","500MG","10","Select","Select",""],["","00406012305","HYDROCO\/APAP","5-325MG","8","Select","Select",""],["","00363051908","PAIN","500MG\/RR","90","Select","Select",""],["","00406055201","OXYCODONE","5MG","42","Select","Select",""],["","00904672059","ACETAMIN","500MG","90","Select","Select",""],["","00406324301","HYDROMORPHON","2MG","12","Select","Select",""],["","31722095001","OXYCOD\/APAP","7.5-325","40","Select","Select",""],["","57237002801","AMOXICILLIN","500MG","30","Select","Select",""],["","57237004105","PENICILLN","500MG","28","Select","Select",""],["","10782010130","VITAMEDMD","ONE RX","90","Select","Select",""],["","69543034030","VIRT-PN","","90","Select","Select",""],["","61314062810","POLYMYXIN","TRIMETHP","10","Select","Select",""],["","65862085901","FAMOTIDINE","20MG","60","Select","Select",""],["","65862018601","CLINDAMYCIN","300MG","14","Select","Select",""],["","80681000900","VITAMIN","50MCG","100","Select","Select",""],["","10702000350","PROMETHAZINE","25MG","30","Select","Select",""],["","31722072690","MONTELUKAST","10MG","30","Select","Select",""],["","45802065087","LORATADINE","10MG","30","Select","Select",""],["","65862078330","ESOMEPRA","20MG DR","30","Select","Select",""],["","60505082901","FLUTICASONE","50MCG","16","Select","Select",""],["","00085113204","PROVENTIL","HFA","7","Select","Select",""],["","64380080707","IBUPROFEN","800MG","60","Select","Select",""],["","00363023820","STOOL","100MG","40","Select","Select",""],["","00093317431","ALBUTEROL","HFA","8","Select","Select",""],["","68180012202","CEPHALEXIN","500MG","28","Select","Select",""],["","65162027250","SMZ\/TMP","800-160","14","Select","Select",""],["","00173072020","FLOVENT","220MCG","12","Select","Select",""],["","00173068220","VENTOLIN","","18","Select","Select",""],["","59267100002","PFIZER","COVID-19","0","Select","Select",""],["","13811058030","ZATEAN-PN ","CAP DHA","30","Select","Select",""],["","59267100002","PFIZER ","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","",""],["No","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":""}]}]}