{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"NATASHA WHITE","gend":1,"add":"1354 28TH ST APT 32C","city":"NEWPORT NEWS","state":"VA","zip":"23607-9998","dob":"2000-07-09","age":"","mstatus":"","insh":"1903697*01","cliId":"","pno":"757\/592-9526","cno":"757\/592-9526","email":"","ename":"","eno":"","pphy":"ASPILI, CONCEPCION MD","ppno":"757\/874-8400","pcpadd":"4714 MARSHALL AVE","pcpcity":"NEWPORT NEWS","pcpstate":"VA","pcpzip":23607,"pcpcounty":"","pcpid":510019,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R41.82","I67.4","I16.1","O15.2","R56.9","R94.5","E83.42","E66.01","NO DATA","R29.818","H10.9","O14.13","I28.0","F33.0","O16.5","R93.1","R41.0","B30.0","O14.14","Z37.0","Z3A.00","G40.909","G93.40","H20.9","L29.9","R68.89","Q21.1","Z34.82","Z3A.17","I10.","Z79.82","Z87.59","O36.5930","Z3A.36","O76.","O36.8120","O70.0","H53.143","E66.9","Z87.891","H53.8","R94.01","F33.2","O09.892","Z13.32","I15.9","Z87.51","F17.200","Z68.32","O99.354","E83.41","F44.89","R53.1","O90.89","O36.8130","O99.344","F41.9","O99.214","F32.2","F17.209","O26.891","O23.41","V23.5","O35.9XX0","O99.213","R40.4","O99.340","Z3A.18","F32.9","O16.3","Z3A.35","G45.9","O13.3","O14.94","Z32.01","V23.9","O10.912","Z3A.24","O10.913","Z3A.28"],"date":["2020-06-29","2020-06-30","2020-06-30","2020-06-30","2021-09-16","2020-06-30","2020-06-30","2020-06-30","2020-09-22","2020-06-30","2020-07-07","2021-06-23","2020-07-07","2020-07-07","2020-08-28","2021-06-24","2020-08-28","2020-10-09","2020-06-28","2020-06-29","2020-06-28","2020-06-29","2020-06-30","2020-09-22","2020-09-22","2020-09-22","2020-10-06","2021-06-24","2021-06-24","2021-06-24","2021-06-24","2021-07-07","2020-06-29","2020-06-29","2020-06-29","2020-06-29","2020-06-29","2020-09-22","2020-09-22","2020-09-22","2020-09-22","2021-09-16","2021-07-07","2021-06-18","2021-06-18","2021-06-18","2021-06-18","2021-06-18","2021-06-18","2020-06-27","2020-06-27","2020-06-27","2020-06-27","2020-06-27","2020-06-27","2020-06-27","2020-06-27","2020-06-27","2020-10-06","2020-10-06","2021-06-01","2021-06-01","2021-08-31","2020-06-26","2020-06-26","2020-09-30","2021-06-23","2021-06-23","2021-06-23","2020-06-23","2020-06-23","2020-06-29","2020-09-29","2020-09-29","2021-05-20","2021-08-31","2021-08-03","2021-08-03","2021-08-31","2021-08-31"],"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":[["","00536408501","PRENATAL ","28-0.8MG","30","Select","Select",""],["","50111033401","METRONIDAZOL ","500MG","4","Select","Select",""],["","57237007810","ONDANSETRON ","8MG ODT","10","Select","Select",""],["","00527169505","BUT\/APAP\/CAF ","","30","Select","Select",""],["","43386055102","TINIDAZOLE ","500MG","4","Select","Select",""],["","00172572860","FAMOTIDINE ","20MG","30","Select","Select",""],["","61314062810","POLYMYXIN ","TRIMETHP","10","Select","Select",""],["","11917009215","FERROUS ","325MG","60","Select","Select",""],["","61314063705","PREDNISOLONE ","1% OP","5","Select","Select",""],["","00574402435","ERYTHROMYCIN ","5MG\/GM","4","Select","Select",""],["","61314064705","TOBRA\/DEXAME ","0.3-0.1%","5","Select","Select",""],["","00536106210","STOOL ","100MG","30","Select","Select",""],["","50742026201","NIFEDIPINE ","90MG ER","30","Select","Select",""],["","00904759080","FEROSUL ","325MG","60","Select","Select",""],["","67877032105","IBUPROFEN ","800MG","30","Select","Select",""],["","65862001205","SERTRALINE ","50MG","30","Select","Select",""],["","00904679480","ASPIRIN ","81MG","30","Select","Select",""],["","59267100003","PFIZER ","COVID-19","0","Select","Select",""],["","64380071206","BENZONATATE ","100MG","30","Select","Select",""],["","50111033401","METRONIDAZOL","500MG","4","Select","Select",""],["","57237007810","ONDANSETRON","8MG ODT","10","Select","Select",""],["","64380071206","BENZONATATE","100MG","30","Select","Select",""],["","00527169505","BUT\/APAP\/CAF","","30","Select","Select",""],["","00172572860","FAMOTIDINE","20MG","30","Select","Select",""],["","43386055102","TINIDAZOLE","500MG","4","Select","Select",""],["","00536408501","PRENATAL","28-0.8MG","30","Select","Select",""],["","11917009215","FERROUS","325MG","60","Select","Select",""],["","00904759080","FEROSUL","325MG","60","Select","Select",""],["","50742026003","NIFEDIPINE","30MG ER","60","Select","Select",""],["","61314062810","POLYMYXIN","TRIMETHP","10","Select","Select",""],["","00904679480","ASPIRIN","81MG","30","Select","Select",""],["","00536106210","STOOL","100MG","30","Select","Select",""],["","67877032105","IBUPROFEN","800MG","30","Select","Select",""],["","61314063705","PREDNISOLONE","1% OP","5","Select","Select",""],["","00574402435","ERYTHROMYCIN","5MG\/GM","4","Select","Select",""],["","61314064705","TOBRA\/DEXAME","0.3-0.1%","5","Select","Select",""],["","65862001205","SERTRALINE","50MG","30","Select","Select",""],["","59267100003","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":""}]}]}