{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SUTRINA   D WHITE","gend":1,"add":"712 LANCER DR","city":"PORTSMOUTH","state":"VA","zip":"23701-9998","dob":"1986-02-23","age":"","mstatus":"","insh":"20041476*01","cliId":"","pno":"757\/535-6855","cno":"757\/535-6855","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":["D50.0","Z30.42","G47.33","I10.","D56.3","D64.9","Z86.018","J06.9","D16.5","R68.84","G89.29","K08.23","G47.34","F70.","I46.9","R06.09","Z68.39","L21.9","L73.2","D56.0","E55.9","E78.5","R06.02","R06.00","K21.9","D50.9","K13.79","Z23.","M79.642","E66.3","G47.30","I34.0","Z68.38","R21.","Z01.419","Z20.2","E66.01","Z68.37","K13.6","L02.11","R30.0","R13.10"],"date":["2020-01-20","2021-07-02","2021-04-15","2021-04-15","2020-08-21","2021-02-24","2020-08-21","2020-11-23","2021-08-26","2021-03-26","2021-03-26","2021-07-12","2021-04-02","2021-10-04","2020-02-12","2020-02-12","2020-02-12","2020-12-23","2021-07-07","2020-05-06","2020-06-30","2021-02-24","2021-03-10","2021-02-17","2020-12-18","2020-10-09","2020-10-09","2021-03-26","2021-02-24","2020-12-18","2021-03-10","2020-01-24","2020-01-24","2020-10-07","2020-11-06","2020-11-06","2020-12-16","2020-12-16","2021-08-24","2021-08-22","2021-09-06","2021-08-26"],"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":[["","42858010201","OXYCOD\/APAP ","5-325MG","20","Select","Select",""],["","16714074703","OMEPRAZOLE ","20MG","30","Select","Select",""],["","57664007110","FERROUS ","325MG","30","Select","Select",""],["","00591060701","LABETALOL ","300MG","60","Select","Select",""],["","24979001001","NIFEDIPINE ","60MG ER","30","Select","Select",""],["","16729018317","HYDROCHLOROT ","25MG","30","Select","Select",""],["","69452015120","VITAMIN ","50000UNT","4","Select","Select",""],["","29300022701","METRONIDAZOL ","500MG","14","Select","Select",""],["","51672129303","CLOBETASOL ","0.05%","100","Select","Select",""],["","00904645780","DOK ","100MG","30","Select","Select",""],["","63646001004","KETOCONAZOLE ","2%","120","Select","Select",""],["","00904759080","FEROSUL ","325MG","90","Select","Select",""],["","00234057504","HIBICLENS ","4%","118","Select","Select",""],["","69452014320","BENZONATATE ","100MG","30","Select","Select",""],["","68382070718","DOXYCYC ","100MG","180","Select","Select",""],["","00115148361","DICLOFENAC ","3%","300","Select","Select",""],["","00054327099","FLUTICASONE ","50MCG","16","Select","Select",""],["","16714079904","CETIRIZINE ","10MG","30","Select","Select",""],["","59762374401","CLINDAMYCIN ","10MG\/ML","60","Select","Select",""],["","65862042005","SMZ\/TMP ","800-160","20","Select","Select",""],["","30698049301","DRISDOL ","50000UNT","12","Select","Select",""],["","80777027399","MODERNA ","COVID-19","0","Select","Select",""],["","51672128402","TRIAMCINOLON ","0.10%","30","Select","Select",""],["","42858000101","OXYCODONE ","5MG","12","Select","Select",""],["","00904662735","EAR ","6.50%","15","Select","Select",""],["","69238110005","DOXYCYCL ","100MG","20","Select","Select",""],["","16714074703","OMEPRAZOLE","20MG","30","Select","Select",""],["","57664007110","FERROUS","325MG","30","Select","Select",""],["","00591060701","LABETALOL","300MG","60","Select","Select",""],["","24979001001","NIFEDIPINE","60MG ER","30","Select","Select",""],["","42858010201","OXYCOD\/APAP","5-325MG","20","Select","Select",""],["","16729018317","HYDROCHLOROT","25MG","30","Select","Select",""],["","29300022701","METRONIDAZOL","500MG","14","Select","Select",""],["","69452015120","VITAMIN","50000UNT","4","Select","Select",""],["","00904645780","DOK","100MG","30","Select","Select",""],["","00904759080","FEROSUL","325MG","90","Select","Select",""],["","63646001004","KETOCONAZOLE","2%","120","Select","Select",""],["","68382070718","DOXYCYC","100MG","180","Select","Select",""],["","51672129303","CLOBETASOL","0.05%","100","Select","Select",""],["","00115148361","DICLOFENAC","3%","300","Select","Select",""],["","16714079904","CETIRIZINE","10MG","30","Select","Select",""],["","00054327099","FLUTICASONE","50MCG","16","Select","Select",""],["","30698049301","DRISDOL","50000UNT","12","Select","Select",""],["","80777027399","MODERNA","COVID-19","0","Select","Select",""],["","00234057504","HIBICLENS","4%","118","Select","Select",""],["","59762374401","CLINDAMYCIN","10MG\/ML","60","Select","Select",""],["","00904662735","EAR","6.50%","15","Select","Select",""],["","69238110005","DOXYCYCL","100MG","20","Select","Select",""],["","51672128402","TRIAMCINOLON","0.10%","30","Select","Select",""],["","42858000101","OXYCODONE","5MG","12","Select","Select",""],["","69452014320","BENZONATATE","100MG","30","Select","Select",""],["","65862042005","SMZ\/TMP","800-160","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","",""],["No","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":""}]}]}