{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KEISHA   S PENN","gend":1,"add":"801 D ST APT 103","city":"CHESAPEAKE","state":"VA","zip":"23324-9998","dob":"1985-11-29","age":"","mstatus":"","insh":"1841177*01","cliId":"","pno":"757\/214-5540","cno":"757\/214-5540","email":"","ename":"","eno":"","pphy":"HANNA, EDWARD S MD","ppno":"757\/436-7888","pcpadd":"675 N BATTLEFIELD BLVD","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":23320,"pcpcounty":"","pcpid":110777,"pcpname":"Battlefield Medical Associates","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/548-5669","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K76.0","K80.10","R10.11","I10.","R79.89","R06.83","J02.9","J32.9","Z86.19","Z23.","S62.326A","F43.23","F32.2","F43.12","F90.0","F84.0","Z30.42","K81.0","R94.5","E87.6","F33.2","V54.12","N64.4","R07.89","E87.8","NO DATA","N60.99","Z20.828","D50.0","E86.0","R73.09","R53.83","Z00.00","E03.9","G47.9","E66.01","Z68.30","F32.9","E66.9","Z68.29","Z20.822","R10.13","R11.2","R06.02","K80.20","G47.30","K80.43","R00.0","E55.9","Z01.411","N89.8","J06.9","G43.909","R60.1","J03.90","R07.0","J35.01","J35.8","G43.009","R20.2","G56.01","K80.50","S62.316A","Z01.812","D24.2","N60.92","L30.9","Z82.49","Z80.3","Z79.3","Z79.899","M79.641","D50.9","R53.82","F90.9","N60.82"],"date":["2020-02-13","2020-02-13","2020-02-13","2021-07-30","2020-02-13","2020-06-09","2020-09-24","2020-09-24","2020-09-24","2020-09-24","2021-01-08","2021-03-30","2021-11-15","2021-11-15","2021-11-15","2021-11-15","2021-10-11","2020-02-15","2020-02-15","2020-02-15","2021-09-27","2021-02-25","2020-04-29","2020-04-29","2020-04-29","2021-01-05","2020-12-14","2021-06-16","2020-02-11","2020-02-11","2020-04-08","2020-09-10","2020-02-11","2021-07-30","2020-02-11","2020-09-10","2020-09-11","2020-10-22","2020-10-22","2021-11-04","2021-06-14","2020-02-13","2020-02-13","2020-02-13","2020-02-13","2020-10-05","2020-02-20","2020-02-20","2021-07-30","2020-09-09","2020-09-09","2020-04-08","2020-04-08","2020-04-08","2020-10-01","2020-10-23","2020-10-23","2020-10-23","2021-03-09","2021-03-09","2021-03-09","2020-02-14","2020-11-15","2020-12-31","2021-11-04","2020-05-22","2020-06-10","2020-11-15","2020-11-15","2020-11-15","2020-11-15","2020-11-15","2021-07-30","2021-07-30","2021-09-14","2021-11-04"],"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":[["","67877019905","AMLODIPINE ","10MG","30","Select","Select",""],["","65162024709","CHLORTHALID ","25MG","30","Select","Select",""],["","00832532411","POT  CL MICRO","10MEQ ER","90","Select","Select",""],["","00143924920","AMOX\/K ","875-125","14","Select","Select",""],["","69784018010","POLYETH ","3350 NF","30","Select","Select",""],["","42858010201","OXYCOD\/APAP ","5-325MG","12","Select","Select",""],["","00703680101","MEDROXYPR ","150MG\/ML","1","Select","Select",""],["","65162046650","IBUPROFEN ","800MG","90","Select","Select",""],["","45802006535","TRIAMCINOLON ","0.50%","60","Select","Select",""],["","59417010410","VYVANSE ","40MG","30","Select","Select",""],["","69238106501","POT  CHLORIDE","10MEQ ER","180","Select","Select",""],["","29300022701","METRONIDAZOL ","500MG","14","Select","Select",""],["","60432026415","FLUTICASONE ","50MCG","16","Select","Select",""],["","00121075908","PREDNISOLONE ","15MG\/5ML","31","Select","Select",""],["","00093417773","CEPHALEXIN ","250\/5ML","200","Select","Select",""],["","65162027210","SMZ\/TMP ","800-160","20","Select","Select",""],["","59762001601","CLINDAMYCIN ","75MG\/5ML","600","Select","Select",""],["","31722094101","HYDROCO\/APAP ","5-325MG","5","Select","Select",""],["","65162067684","AZELASTINE ","0.10%","30","Select","Select",""],["","59746017506","PREDNISONE ","20MG","11","Select","Select",""],["","65162003310","APAP\/CODEINE ","300-30MG","24","Select","Select",""],["","00406889301","AMPHET\/DEXTR ","20MG","60","Select","Select",""],["","64380071206","BENZONATATE ","100MG","21","Select","Select",""],["","65862039010","ONDANSETRON ","4MG ODT","10","Select","Select",""],["","65162024709","CHLORTHALID","25MG","30","Select","Select",""],["","67877019905","AMLODIPINE","10MG","30","Select","Select",""],["","00832532411","POT CL MICRO","10MEQ ER","90","Select","Select",""],["","00143924920","AMOX\/K","875-125","14","Select","Select",""],["","69784018010","POLYETH","3350 NF","30","Select","Select",""],["","42858010201","OXYCOD\/APAP","5-325MG","12","Select","Select",""],["","45802006535","TRIAMCINOLON","0.50%","60","Select","Select",""],["","00703680101","MEDROXYPR","150MG\/ML","1","Select","Select",""],["","29300022701","METRONIDAZOL","500MG","14","Select","Select",""],["","60219106501","POT CHLORIDE","10MEQ ER","90","Select","Select",""],["","00093417773","CEPHALEXIN","250\/5ML","200","Select","Select",""],["","60432026415","FLUTICASONE","50MCG","16","Select","Select",""],["","59762001601","CLINDAMYCIN","75MG\/5ML","600","Select","Select",""],["","00121075908","PREDNISOLONE","15MG\/5ML","31","Select","Select",""],["","65162027210","SMZ\/TMP","800-160","20","Select","Select",""],["","65162067684","AZELASTINE","0.10%","30","Select","Select",""],["","65162046650","IBUPROFEN","800MG","90","Select","Select",""],["","59746017506","PREDNISONE","20MG","11","Select","Select",""],["","65162003310","APAP\/CODEINE","300-30MG","24","Select","Select",""],["","59417010410","VYVANSE","40MG","30","Select","Select",""],["","00406889301","AMPHET\/DEXTR","20MG","60","Select","Select",""],["","64380071206","BENZONATATE","100MG","21","Select","Select",""],["","65862039010","ONDANSETRON","4MG ODT","10","Select","Select",""],["","54092038501","ADDERALL","15MG","30","Select","Select",""],["","31722094101","HYDROCO\/APAP","5-325MG","5","Select","Select",""],["","54092038501","ADDERALL ","CAP 15MG","30","Select","Select",""],["","42192080201","PHENAZOPYRID ","TAB 200MG","9","Select","Select",""],["","67877021560","CEFUROXIME ","TAB 250MG","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":""}]}]}