{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JACKLYN   L STONE","gend":1,"add":"324 WHITEHURST LNDG","city":"CHESAPEAKE","state":"VA","zip":"23320-9998","dob":"1985-07-26","age":"","mstatus":"","insh":"1789362*01","cliId":"","pno":"757\/478-9592","cno":"757\/478-9592","email":"","ename":"","eno":"","pphy":"REED, PAULINE C MD","ppno":"757\/228-1288","pcpadd":"490 LIBERTY STREET","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":23324,"pcpcounty":"","pcpid":153229,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"757\/351-9791","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["S83.212A","S83.242A","Z32.01","F32.0","F90.2","F43.23","O26.852","Z3A.17","Z34.82","Z36.9","Z20.828","R05.","R53.83","NO DATA","R68.83","R07.0","O42.113","Z37.0","O99.02","D64.9","O99.214","E66.9","Z79.82","Z3A.36","O42.913","Z3A.35","M51.26","M54.6","R00.0","F90.0","O46.93","O09.522","O35.1XX0","Z3A.15","O99.891","M54.5","Z3A.34","S76.312A","M76.892","Z36.2","O35.2XX0","O34.30","Z3A.16","Z39.0","A60.00","L74.9","F43.9","B37.3","O80."],"date":["2020-01-24","2020-02-12","2020-08-25","2020-09-24","2020-09-24","2020-09-24","2020-11-16","2020-11-16","2020-11-16","2020-11-16","2020-12-04","2020-12-04","2020-12-04","2020-12-04","2020-12-04","2020-12-04","2021-03-23","2021-03-24","2021-03-24","2021-03-24","2021-03-23","2021-03-23","2021-03-23","2021-03-23","2021-03-23","2021-03-24","2021-02-12","2021-02-25","2020-08-24","2020-07-27","2021-03-23","2020-11-06","2020-10-29","2020-10-29","2021-02-04","2021-02-04","2021-02-04","2020-02-12","2020-02-12","2020-11-06","2020-11-06","2020-11-06","2020-11-06","2021-03-26","2020-03-23","2020-03-23","2020-03-23","2020-04-07","2021-03-24"],"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":[["","00555097302","AMPHET\/DEXTR ","20MG","90","Select","Select",""],["","00378427577","VALACYCLOVIR ","500MG","18","Select","Select",""],["","68462010340","FLUCONAZOLE ","150MG","1","Select","Select",""],["","00363058714","ASPIRIN ","81MG EC","30","Select","Select",""],["","64380080707","IBUPROFEN ","800MG","30","Select","Select",""],["","50419042301","MIRENA ","SYSTEM","1","Select","Select",""],["","65862056090","PANTOPRAZOLE ","40MG","90","Select","Select",""],["","57237007710","ONDANSETRON ","4MG ODT","20","Select","Select",""],["","10702000350","PROMETHAZINE ","25MG","20","Select","Select",""],["","37000045504","PRILOSEC ","20MG","42","Select","Select",""],["","52817033200","CYCLOBENZAPR ","10MG","42","Select","Select",""],["","00406051205","OXYCOD\/APAP ","5-325MG","24","Select","Select",""],["","59267100001","PFIZER ","COVID-19","0","Select","Select",""],["","00555097302","AMPHET\/DEXTR","20MG","90","Select","Select",""],["","00378427577","VALACYCLOVIR","500MG","18","Select","Select",""],["","57237000511","FLUCONAZOLE","150MG","1","Select","Select",""],["","10702000350","PROMETHAZINE","25MG","20","Select","Select",""],["","00363058714","ASPIRIN","81MG EC","30","Select","Select",""],["","57237007710","ONDANSETRON","4MG ODT","20","Select","Select",""],["","65862056090","PANTOPRAZOLE","40MG","90","Select","Select",""],["","37000045504","PRILOSEC","20MG","42","Select","Select",""],["","00406051205","OXYCOD\/APAP","5-325MG","24","Select","Select",""],["","64380080707","IBUPROFEN","800MG","30","Select","Select",""],["","52817033200","CYCLOBENZAPR","10MG","42","Select","Select",""],["","50419042301","MIRENA","SYSTEM","1","Select","Select",""],["","59267100001","PFIZER","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":""}]}]}