{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"REGINA PUCKETT","gend":1,"add":"21188 THOMAS WOODS TRL","city":"ZUNI","state":"VA","zip":"23898-9998","dob":"1961-11-13","age":"","mstatus":"","insh":"20033662*01","cliId":"","pno":"757\/332-3519","cno":"757\/332-3519","email":"","ename":"","eno":"","pphy":"WILLIAMS, VALENCIA J MD","ppno":"757\/294-3981","pcpadd":"440 COLONIAL TRL W","pcpcity":"DENDRON","pcpstate":"VA","pcpzip":23839,"pcpcounty":"","pcpid":671580,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/294-3985","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R51.","R53.1","R42.","L70.0","Z71.9","N30.00","Z79.899","Z23.","J44.9","E78.9","F17.200","K21.9","E11.9","I10.","E55.9","J45.909","M19.90","R11.0","F41.9","Z87.891","E11.42","L84.","B35.1","R39.9","Z71.3","Z71.6","Z68.26","Z01.818","K42.9","M54.5","Q76.2","M51.36","M47.819","M54.16","M79.7","Z01.810","R94.31","Z53.8","M06.9","Z79.84","Z90.49","Z82.49","Z82.3","N13.2","K58.9","Z86.718","Z98.890","F90.9","Z79.51","R10.9","NO DATA","N20.1"],"date":["2020-07-06","2020-07-06","2020-07-16","2021-10-05","2021-09-07","2020-07-06","2021-11-03","2021-06-18","2021-11-03","2020-05-11","2020-07-16","2021-10-22","2021-11-03","2021-10-22","2020-05-11","2020-07-16","2020-05-11","2020-05-11","2020-05-11","2021-11-03","2020-01-24","2020-01-24","2020-01-24","2020-07-16","2020-07-16","2020-07-16","2020-07-16","2021-07-19","2021-10-22","2021-08-03","2021-11-24","2021-11-24","2021-11-24","2021-11-24","2021-11-24","2021-07-26","2021-07-26","2021-08-04","2021-11-03","2021-11-03","2021-11-03","2021-10-22","2021-10-22","2021-11-03","2021-11-03","2021-11-03","2021-11-03","2021-11-03","2021-11-03","2021-11-03","2021-11-24","2021-11-03"],"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":[["","00069046903","CHANTIX ","1MG","56","Select","Select",""],["","69452015120","VITAMIN ","50000UNT","4","Select","Select",""],["","68180065001","DOXYCYC ","50MG","60","Select","Select",""],["","16729020201","BUSPIRONE ","10MG","120","Select","Select",""],["","70377002811","ATORVASTATIN ","20MG","30","Select","Select",""],["","65862086001","FAMOTIDINE ","40MG","30","Select","Select",""],["","51991074790","DULOXETINE ","30MG","60","Select","Select",""],["","00310737020","BUDES\/FORMOT ","160-4.5","10","Select","Select",""],["","51672411606","METRONIDAZOL ","0.75%","45","Select","Select",""],["","13668015630","TELMISARTAN ","20MG","30","Select","Select",""],["","57664047758","METOPROL ","50MG","60","Select","Select",""],["","00186037020","SYMBICORT ","160-4.5","10","Select","Select",""],["","68462010530","ONDANSETRON ","4MG","30","Select","Select",""],["","00299383645","METROCREAM ","0.75%","45","Select","Select",""],["","68382075810","METFORMIN ","500MG","15","Select","Select",""],["","00299383802","METROLOTION ","0.75%","59","Select","Select",""],["","68180012202","CEPHALEXIN ","500MG","20","Select","Select",""],["","73473030030","CLINDAMYCIN ","1%","30","Select","Select",""],["","14539067401","HYDROXYZ ","25MG","90","Select","Select",""],["","45802065078","LORATADINE ","10MG","30","Select","Select",""],["","65162044210","MECLIZINE ","25MG","15","Select","Select",""],["","58657045001","PHENAZOPYRID ","100MG","12","Select","Select",""],["","65862042005","SMZ\/TMP ","800-160","20","Select","Select",""],["","43598029390","PREGABALIN ","75MG","60","Select","Select",""],["","57237001401","TAMSULOSIN ","0.4MG","7","Select","Select",""],["","65862007701","CIPROFLOXACN ","500MG","20","Select","Select",""],["","69238101703","ISOTRETINOIN ","30MG","60","Select","Select",""],["","00555105786","CLARAVIS ","40MG","30","Select","Select",""],["","00591565810","CYCLOBENZAPR ","10MG","20","Select","Select",""],["","60505476606","APO-VARENICL ","1MG","60","Select","Select",""],["","00069046903","CHANTIX","1MG","56","Select","Select",""],["","65862086001","FAMOTIDINE","40MG","30","Select","Select",""],["","51991074790","DULOXETINE","30MG","60","Select","Select",""],["","68180065001","DOXYCYC","50MG","60","Select","Select",""],["","69452015120","VITAMIN","50000UNT","4","Select","Select",""],["","13668015630","TELMISARTAN","20MG","30","Select","Select",""],["","16729020201","BUSPIRONE","10MG","120","Select","Select",""],["","00186037020","SYMBICORT","160-4.5","10","Select","Select",""],["","57664047758","METOPROL","50MG","60","Select","Select",""],["","00310737020","BUDES\/FORMOT","160-4.5","10","Select","Select",""],["","70377002811","ATORVASTATIN","20MG","30","Select","Select",""],["","51672411606","METRONIDAZOL","0.75%","45","Select","Select",""],["","68382075810","METFORMIN","500MG","15","Select","Select",""],["","00299383802","METROLOTION","0.75%","59","Select","Select",""],["","00299383645","METROCREAM","0.75%","45","Select","Select",""],["","68180012202","CEPHALEXIN","500MG","15","Select","Select",""],["","68462010530","ONDANSETRON","4MG","30","Select","Select",""],["","65162044210","MECLIZINE","25MG","15","Select","Select",""],["","58657045001","PHENAZOPYRID","100MG","12","Select","Select",""],["","65862042005","SMZ\/TMP","800-160","20","Select","Select",""],["","45802065078","LORATADINE","10MG","30","Select","Select",""],["","65862007701","CIPROFLOXACN","500MG","20","Select","Select",""],["","43598029390","PREGABALIN","75MG","60","Select","Select",""],["","57237001401","TAMSULOSIN","0.4MG","7","Select","Select",""],["","73473030030","CLINDAMYCIN","1%","30","Select","Select",""],["","00555105786","CLARAVIS","40MG","30","Select","Select",""],["","14539067401","HYDROXYZ","25MG","90","Select","Select",""],["","00591565810","CYCLOBENZAPR","10MG","20","Select","Select",""],["","60505476606","APO-VARENICL","1MG","60","Select","Select",""],["","69238101703","ISOTRETINOIN","30MG","60","Select","Select",""],["","00904699880","DOCUSATE ","CAP 100MG","30","Select","Select",""],["","00406012305","HYDROCO\/APAP ","TAB 5-325MG","30","Select","Select",""],["","42858010201","OXYCOD\/APAP ","TAB 5-325MG","12","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":[[["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Yes","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":""}]}]}