{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KATHERINE   O SYKES","gend":1,"add":"1400 LAKE FOREST DR","city":"PORTSMOUTH","state":"VA","zip":"23701-9998","dob":"2001-01-29","age":"","mstatus":"","insh":"20041442*01","cliId":"","pno":"757\/606-2174","cno":"757\/606-2174","email":"","ename":"","eno":"","pphy":"REINEKE-PIPER, KRISTEN MD","ppno":"757\/488-3333","pcpadd":"3925 PORTSMOUTH BLVD","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":23321,"pcpcounty":"","pcpid":137859,"pcpname":"Family Medicine Health Care","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/488-0007","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F70.","F84.0","F90.9","F41.9","O20.0","R10.9","F34.1","NO DATA","N76.0","Z11.3","Z20.828","N83.209","J34.89","R05.","R04.0","J30.2","J38.4","Z03.818","V23.87","N73.6","R18.8","N83.8","J06.9","N92.1","Z32.01","O02.1","F91.3","N30.00","M70.42","M70.929","O34.599"],"date":["2020-01-31","2020-01-31","2020-10-29","2020-09-24","2021-05-15","2020-03-12","2020-10-29","2020-12-06","2020-12-06","2020-12-06","2021-04-01","2021-04-09","2020-03-06","2020-03-06","2020-03-06","2020-03-06","2020-03-06","2020-07-09","2021-04-08","2021-04-09","2021-04-09","2021-04-09","2020-01-06","2020-01-06","2021-04-19","2021-05-17","2020-01-17","2021-01-07","2021-01-07","2021-01-07","2021-04-19"],"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":[["","59417010310","VYVANSE ","30MG","30","Select","Select",""],["","65862001330","SERTRALINE ","100MG","30","Select","Select",""],["","60432026415","FLUTICASONE ","50MCG","16","Select","Select",""],["","59762444002","METHYLPRED ","4MG","21","Select","Select",""],["","65862039010","ONDANSETRON ","4MG ODT","14","Select","Select",""],["","65162046510","IBUPROFEN ","600MG","18","Select","Select",""],["","65162027210","SMZ\/TMP ","800-160","14","Select","Select",""],["","47781030301","NITROFURANTN ","100MG","10","Select","Select",""],["","00603497821","OXYCOD\/APAP ","2.5-325","10","Select","Select",""],["","00642007912","VITAFOL-OB ","65-1MG","30","Select","Select",""],["","68462019005","NAPROXEN ","500MG","20","Select","Select",""],["","29300022705","METRONIDAZOL ","500MG","14","Select","Select",""],["","00904671960","ACETAMINOPHE ","325MG","60","Select","Select",""],["","69543025850","PREPLUS ","27-1MG","30","Select","Select",""],["","59762500801","MISOPROSTOL ","200MCG","8","Select","Select",""],["","59762444002","METHYLPRED","4MG","21","Select","Select",""],["","60432026415","FLUTICASONE","50MCG","16","Select","Select",""],["","65162046510","IBUPROFEN","600MG","18","Select","Select",""],["","65162027210","SMZ\/TMP","800-160","14","Select","Select",""],["","29300022705","METRONIDAZOL","500MG","14","Select","Select",""],["","00185012201","NITROFURANTN","100MG","10","Select","Select",""],["","68462018905","NAPROXEN","375MG","20","Select","Select",""],["","00642007912","VITAFOL-OB","65-1MG","30","Select","Select",""],["","00603497821","OXYCOD\/APAP","2.5-325","10","Select","Select",""],["","57896010201","ACETAMINOPHE","325MG","60","Select","Select",""],["","69543025850","PREPLUS","27-1MG","30","Select","Select",""],["","59762500801","MISOPROSTOL","200MCG","8","Select","Select",""],["","59417010310","VYVANSE","30MG","30","Select","Select",""],["","65862001330","SERTRALINE","100MG","30","Select","Select",""],["","65862039010","ONDANSETRON","4MG ODT","14","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","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["No","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":""}]}]}