{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MONICA CAMPBELL","gend":1,"add":"3013 INDIAN RIVER RD APT A","city":"CHESAPEAKE","state":"VA","zip":"23325-9998","dob":"1962-11-10","age":"","mstatus":"","insh":"20044515*01","cliId":"","pno":"757\/955-4496","cno":"757\/955-4496","email":"","ename":"","eno":"","pphy":"HANNA, EDWARD S MD","ppno":"757\/436-7888","pcpadd":"675 N BATTLEFIELD BLVD","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":23320,"pcpcounty":"","pcpid":110777,"pcpname":"Battlefield Medical Associates","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/548-5669","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M54.16","M41.26","G89.4","M25.562","N81.84","R32.","J06.9","J45.909","J44.9","I10.","M17.12","S33.5XXA","F25.9","F33.1","F43.10","N31.9","S05.02XA","J44.1","R06.02","R05.","N39.41","R87.810","Z48.89","M62.08","L98.7","Z98.84","K43.2","R19.7","R63.4","E65.","M54.6","S31.109A","M54.5","K91.2","E61.1","E51.9","J11.1","R26.9","I73.9","M79.674","M79.675","H18.823","H52.03","H52.223","H52.4","R10.33","L08.9","D50.8","Z03.818","Z20.828","K04.7","Z00.00","R87.619"],"date":["2021-09-30","2021-09-30","2021-09-30","2021-09-30","2021-11-05","2021-11-09","2020-03-18","2020-08-03","2021-11-05","2021-04-27","2020-03-18","2020-03-18","2021-11-05","2021-03-15","2021-06-01","2021-11-09","2020-12-12","2020-12-12","2020-12-12","2020-12-12","2021-11-05","2020-09-25","2021-07-23","2021-08-16","2021-08-16","2021-08-16","2021-08-16","2020-09-21","2020-01-02","2020-06-12","2020-06-12","2021-08-02","2021-04-05","2020-06-16","2020-06-16","2020-06-16","2020-12-12","2021-04-11","2021-04-11","2021-04-11","2021-04-11","2021-07-22","2021-07-22","2021-07-22","2021-07-22","2021-07-23","2021-07-23","2021-04-27","2020-05-29","2020-09-14","2021-09-15","2021-10-29","2021-10-29"],"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":[["","50428038158","VITAMIN ","500MG","30","Select","Select",""],["","00536100901","FERROUS ","325MG","30","Select","Select",""],["","45802049383","AMMONIUM ","12%","140","Select","Select",""],["","68382080505","TRAZODONE ","50MG","90","Select","Select",""],["","51672126303","NYSTAT\/TRIAM ","","60","Select","Select",""],["","00054327099","FLUTICASONE ","50MCG","16","Select","Select",""],["","00406052301","OXYCOD\/APAP ","10-325MG","60","Select","Select",""],["","68180072103","AMLODIPINE ","10MG","30","Select","Select",""],["","65862001305","SERTRALINE ","100MG","30","Select","Select",""],["","62175061743","PANTOPRAZOLE ","40MG","30","Select","Select",""],["","00093742698","MONTELUKAST ","10MG","30","Select","Select",""],["","00093300993","LANSOPRAZOLE ","30MG","30","Select","Select",""],["","00093221001","SUCRALFATE ","1GM","360","Select","Select",""],["","00310737020","BUDES\/FORMOT ","160-4.5","10","Select","Select",""],["","00186037020","SYMBICORT ","160-4.5","10","Select","Select",""],["","71093014005","METHOCARBAM ","500MG","30","Select","Select",""],["","51672404801","CLOTRIM\/BETA ","DIPROP","60","Select","Select",""],["","00115521116","COLESTIPOL ","1GM","60","Select","Select",""],["","00093317431","ALBUTEROL ","HFA","8","Select","Select",""],["","58160082311","SHINGRIX ","50\/0.5ML","1","Select","Select",""],["","69547035302","NARCAN ","","2","Select","Select",""],["","24208091055","ERYTHROMYCIN ","5MG\/GM","4","Select","Select",""],["","67877057305","BENZONATATE ","100MG","21","Select","Select",""],["","45802057178","FEXOFENADINE ","180MG","14","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","41167041251","ALLEGRA ","180MG","14","Select","Select",""],["","59267100003","PFIZER ","COVID-19","0","Select","Select",""],["","00006483703","PNEUMOVAX ","25\/0.5","0","Select","Select",""],["","58160084252","BOOSTRIX ","","1","Select","Select",""],["","00005197102","PREVNAR ","","0","Select","Select",""],["","62135062650","DOXYCYCL ","100MG","20","Select","Select",""],["","00904052380","VITAMIN","500MG","30","Select","Select",""],["","68382080505","TRAZODONE","50MG","90","Select","Select",""],["","00054327099","FLUTICASONE","50MCG","16","Select","Select",""],["","00536100901","FERROUS","325MG","30","Select","Select",""],["","65862001305","SERTRALINE","100MG","30","Select","Select",""],["","00406052301","OXYCOD\/APAP","10-325MG","60","Select","Select",""],["","62175061743","PANTOPRAZOLE","40MG","30","Select","Select",""],["","68180072103","AMLODIPINE","10MG","30","Select","Select",""],["","00093300993","LANSOPRAZOLE","30MG","30","Select","Select",""],["","00310737020","BUDES\/FORMOT","160-4.5","10","Select","Select",""],["","45802049383","AMMONIUM","12%","140","Select","Select",""],["","00093221001","SUCRALFATE","1GM","360","Select","Select",""],["","71093014005","METHOCARBAM","500MG","30","Select","Select",""],["","51672126303","NYSTAT\/TRIAM","","60","Select","Select",""],["","00186037020","SYMBICORT","160-4.5","10","Select","Select",""],["","00093742698","MONTELUKAST","10MG","30","Select","Select",""],["","51672404801","CLOTRIM\/BETA","DIPROP","60","Select","Select",""],["","00115521116","COLESTIPOL","1GM","60","Select","Select",""],["","69547035302","NARCAN","","2","Select","Select",""],["","00093317431","ALBUTEROL","HFA","8","Select","Select",""],["","67877057305","BENZONATATE","100MG","21","Select","Select",""],["","45802057178","FEXOFENADINE","180MG","14","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","41167041251","ALLEGRA","180MG","14","Select","Select",""],["","58160084252","BOOSTRIX","","1","Select","Select",""],["","00005197102","PREVNAR","","0","Select","Select",""],["","58160082311","SHINGRIX","50\/0.5ML","1","Select","Select",""],["","62135062650","DOXYCYCL","100MG","20","Select","Select",""],["","59267100002","PFIZER","COVID-19","0","Select","Select",""],["","00006483703","PNEUMOVAX","25\/0.5","0","Select","Select",""],["","63304069301","CLINDAMYCIN","300MG","21","Select","Select",""],["","71930005552","APAP\/CODEINE","300-30MG","10","Select","Select",""],["","24208091055","ERYTHROMYCIN","5MG\/GM","4","Select","Select",""],["","71930005552","APAP\/CODEINE ","TAB 300-30MG","10","Select","Select",""],["","63304069301","CLINDAMYCIN ","CAP 300MG","21","Select","Select",""],["","58160082152","ENGERIX-B ","INJ 20MCG\/ML","1","Select","Select",""],["","49281042150","FLUZONE ","INJ 2021-22","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","",""],["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":""}]}]}