{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CYNTHIA   A DAVIS","gend":1,"add":"1336 LONGDALE DR APT 201","city":"NORFOLK","state":"VA","zip":"23513-9998","dob":"1961-01-19","age":"","mstatus":"","insh":"20038168*01","cliId":"","pno":"757\/339-1739","cno":"757\/339-1739","email":"","ename":"","eno":"","pphy":"WHITEHURST, CANDACE MD","ppno":"757\/622-8358","pcpadd":"930 W 21ST ST STE 100","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23517,"pcpcounty":"","pcpid":207883,"pcpname":"BON SECOURS GHENT STATION MEDICAL ASSOCIATES","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"757\/352-1671","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/622-9662","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M70.61","M70.62","N30.01","M47.812","M54.2","K22.8","K44.9","R13.10","K21.9","I10.","E11.40","M25.552","N89.8","Z68.28","Z12.11","Z80.0","K63.5","R68.81","K30.","M19.011","M75.31","N30.00","N76.0","D72.819","R00.2","E11.9","E04.1","E55.9","Z01.812","U07.1","J18.9","NO DATA","H00.014","Z76.0","Z68.29","Z68.30","Z20.822","M15.9","M19.041","M75.41","D12.2","K64.8","M51.37","M54.17","M16.12","M50.30","E11.21","Z68.31","M79.641","R06.00","R31.9","Z79.84","M54.16","M47.816","Z71.89","M79.652","R19.07","M51.36","Z23.","I67.1","R19.00","M25.559","Z68.27"],"date":["2020-07-13","2021-08-16","2021-03-31","2020-10-22","2020-10-22","2021-03-16","2021-03-16","2021-07-06","2021-07-06","2021-08-10","2021-08-10","2021-04-07","2021-04-07","2021-04-07","2021-04-09","2021-04-09","2021-04-09","2021-07-06","2021-07-06","2020-02-17","2020-02-17","2020-10-02","2020-10-02","2020-10-02","2021-08-24","2021-04-19","2021-04-19","2020-12-03","2021-04-07","2021-03-04","2021-03-11","2021-03-29","2021-03-29","2020-01-21","2020-01-21","2020-08-04","2021-04-07","2020-01-16","2020-02-24","2020-02-24","2021-04-09","2021-04-09","2021-06-15","2021-06-15","2021-08-16","2020-09-21","2020-12-07","2020-12-07","2020-03-10","2020-03-10","2021-03-31","2021-03-31","2021-06-29","2021-06-29","2021-06-29","2021-03-22","2021-08-16","2021-06-15","2021-08-10","2021-08-30","2021-09-02","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":[["","00591042405","TRIAMT\/HCTZ ","37.5-25","90","Select","Select",""],["","60505083001","MOMETASONE ","50MCG","17","Select","Select",""],["","49884071953","TIZANIDINE ","4MG","90","Select","Select",""],["","00006008131","JANUMET ","100-1000","30","Select","Select",""],["","45963070911","METOPROL ","25MG ER","15","Select","Select",""],["","27241009803","DULOXETINE ","30MG","30","Select","Select",""],["","69452015120","VITAMIN ","50000UNT","4","Select","Select",""],["","00078035834","DIOVAN ","80MG","30","Select","Select",""],["","64980028101","GLIPIZIDE ","10MG","30","Select","Select",""],["","00591505210","PREDNISONE ","5MG","30","Select","Select",""],["","65162010250","GABAPENTIN ","300MG","180","Select","Select",""],["","65162062711","TRAMADOL ","50MG","90","Select","Select",""],["","00310653004","BYDUREON ","2MG","4","Select","Select",""],["","70710122700","AMITRIPTYLIN ","50MG","30","Select","Select",""],["","00093317431","ALBUTEROL ","HFA","8","Select","Select",""],["","00169413212","OZEMPIC ","2\/1.5ML","2","Select","Select",""],["","00597015230","JARDIANCE ","10MG","30","Select","Select",""],["","08290320550","BD  PEN NEEDL","32GX5\/32","100","Select","Select",""],["","65862018601","CLINDAMYCIN ","300MG","40","Select","Select",""],["","51224000760","METFORMIN ","500MG ER","120","Select","Select",""],["","57237000511","FLUCONAZOLE ","150MG","1","Select","Select",""],["","00169406013","VICTOZA ","18MG\/3ML","9","Select","Select",""],["","33342006310","VALSARTAN ","80MG","30","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","24208035810","ZYLET ","0.5-0.3%","10","Select","Select",""],["","68382050010","OMEPRAZOLE ","40MG","30","Select","Select",""],["","61314063006","NEO\/POLY\/DEX ","0.1% OP","5","Select","Select",""],["","00185012201","NITROFURANTN ","100MG","10","Select","Select",""],["","45802086866","POLYETH ","3350 NF","56","Select","Select",""],["","69238110005","DOXYCYCL ","100MG","20","Select","Select",""],["","59762040101","SUCRALFATE ","1GM","60","Select","Select",""],["","59267100001","PFIZER ","COVID-19","0","Select","Select",""],["","59746000103","METHYLPRED ","4MG","21","Select","Select",""],["","00406012305","HYDROCO\/APAP ","5-325MG","15","Select","Select",""],["","00591505210","PREDNISONE","5MG","30","Select","Select",""],["","00310653004","BYDUREON","2MG","4","Select","Select",""],["","60505083001","MOMETASONE","50MCG","17","Select","Select",""],["","62037083001","METOPROL","25MG ER","15","Select","Select",""],["","65162010250","GABAPENTIN","300MG","180","Select","Select",""],["","65162062711","TRAMADOL","50MG","90","Select","Select",""],["","49884071953","TIZANIDINE","4MG","90","Select","Select",""],["","00006008131","JANUMET","100-1000","30","Select","Select",""],["","00078035834","DIOVAN","80MG","30","Select","Select",""],["","64980028101","GLIPIZIDE","10MG","30","Select","Select",""],["","69452015120","VITAMIN","50000UNT","4","Select","Select",""],["","27241009803","DULOXETINE","30MG","30","Select","Select",""],["","00591042405","TRIAMT\/HCTZ","37.5-25","30","Select","Select",""],["","70710122700","AMITRIPTYLIN","50MG","30","Select","Select",""],["","45802086866","POLYETH","3350 NF","56","Select","Select",""],["","00093317431","ALBUTEROL","HFA","8","Select","Select",""],["","57237000511","FLUCONAZOLE","150MG","1","Select","Select",""],["","33342006310","VALSARTAN","80MG","30","Select","Select",""],["","00185012201","NITROFURANTN","100MG","10","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","00169413212","OZEMPIC","2\/1.5ML","2","Select","Select",""],["","08290320883","BD PEN NEEDL","32GX4MM","100","Select","Select",""],["","00597015230","JARDIANCE","10MG","30","Select","Select",""],["","51224000760","METFORMIN","500MG ER","120","Select","Select",""],["","65862018601","CLINDAMYCIN","300MG","40","Select","Select",""],["","68382050010","OMEPRAZOLE","40MG","30","Select","Select",""],["","00169406013","VICTOZA","18MG\/3ML","9","Select","Select",""],["","24208035810","ZYLET","0.5-0.3%","10","Select","Select",""],["","59762040101","SUCRALFATE","1GM","60","Select","Select",""],["","61314063006","NEO\/POLY\/DEX","0.1% OP","5","Select","Select",""],["","00406012305","HYDROCO\/APAP","5-325MG","15","Select","Select",""],["","59746000103","METHYLPRED","4MG","21","Select","Select",""],["","59267100001","PFIZER","COVID-19","0","Select","Select",""],["","29300012510","MELOXICAM","15MG","30","Select","Select",""],["","69238110005","DOXYCYCL","100MG","20","Select","Select",""],["","29300012510","MELOXICAM ","TAB 15MG","30","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":""}]}]}