{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KATRINA   D VAN DYKE-WILKINS","gend":1,"add":"391 MISTY CREEK CT APT G","city":"NEWPORT NEWS","state":"VA","zip":23607,"dob":"1977-08-13","age":"","mstatus":"","insh":"2089932*01","cliId":"","pno":"757\/369-0683","cno":"757\/369-0683","email":"","ename":"","eno":"","pphy":"FRIEND, CLARENCE W MD","ppno":"757\/874-8400","pcpadd":"15425-H WARWICK BLVD","pcpcity":"NEWPORT NEWS","pcpstate":"VA","pcpzip":23607,"pcpcounty":"","pcpid":102269,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/947-2001","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z00.00","I10.","NO DATA","Z12.39","K21.9","R07.9","F33.1","G43.809","R56.9","M25.531","R29.898","M79.641","M65.351","S66.811A","D25.0","N76.2","F41.0","A60.00","M25.512","G40.909","Z13.0","Z12.31","N63.10","A49.9","Z32.02","G43.009","F41.8","N92.1","G43.909","Z11.3","N89.8","B37.3","R89.5","Z01.411","S63.696A","G44.209","N76.0","N84.0","V58.89","F41.1","M54.6","G89.29"],"date":["2020-01-27","2021-08-25","2020-01-27","2020-01-27","2020-02-17","2020-01-27","2021-08-25","2020-04-03","2020-05-28","2020-07-22","2020-07-22","2021-04-27","2021-02-12","2021-02-12","2021-01-25","2020-08-26","2021-08-25","2021-06-30","2021-06-30","2021-06-30","2021-06-30","2021-06-30","2021-06-30","2020-12-23","2020-12-09","2020-03-03","2020-03-03","2021-01-25","2020-05-28","2020-08-21","2020-12-04","2020-08-21","2020-08-21","2020-12-04","2021-04-27","2020-05-28","2020-06-16","2021-01-25","2021-04-23","2021-08-25","2021-08-25","2021-08-25"],"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":[["","65862052730","VENLAFAXINE ","37.5 ER","30","Select","Select",""],["","65862044830","VALACYCLOVIR ","500MG","30","Select","Select",""],["","00591060501","LABETALOL ","100MG","60","Select","Select",""],["","68645049254","PANTOPRAZOLE ","40MG","30","Select","Select",""],["","68645055754","LISINOP\/HCTZ ","20-12.5","30","Select","Select",""],["","68645056354","IBUPROFEN ","800MG","30","Select","Select",""],["","29300022019","MONTELUKAST ","10MG","30","Select","Select",""],["","49035049101","PAIN ","325MG","30","Select","Select",""],["","50383077504","LIDOCAINE ","2% VISC","100","Select","Select",""],["","00591024105","LORAZEPAM ","1MG","1","Select","Select",""],["","49035052378","ACETAMINOPHN ","325MG","30","Select","Select",""],["","50111043301","TRAZODONE ","50MG","30","Select","Select",""],["","43386016106","MISOPROSTOL ","200MCG","3","Select","Select",""],["","33342009441","RIZATRIPTAN ","10MG ODT","9","Select","Select",""],["","70710113908","FLUCONAZOLE ","150MG","2","Select","Select",""],["","42806031250","DOXYCYCL ","100MG","14","Select","Select",""],["","68382004101","PROMETHAZINE ","25MG","20","Select","Select",""],["","50228018005","GABAPENTIN ","300MG","2","Select","Select",""],["","68382005105","MELOXICAM ","15MG","30","Select","Select",""],["","00143993905","AMOXICILLIN ","500MG","30","Select","Select",""],["","43547028111","ESCITALOPRAM ","10MG","30","Select","Select",""],["","69918030130","TRANEX ","650MG","20","Select","Select",""],["","51672130200","TERCONAZOLE ","0.80%","20","Select","Select",""],["","50111033402","METRONIDAZOL ","500MG","14","Select","Select",""],["","00172392770","DIAZEPAM ","10MG","1","Select","Select",""],["","31722099601","HYDROCO\/APAP ","5-325MG","20","Select","Select",""],["","59267100001","PFIZER ","COVID-19","0","Select","Select",""],["","65862044830","VALACYCLOVIR","500MG","30","Select","Select",""],["","68645055754","LISINOP\/HCTZ","20-12.5","30","Select","Select",""],["","65862052830","VENLAFAXINE","75MG ER","30","Select","Select",""],["","00591060501","LABETALOL","100MG","60","Select","Select",""],["","68645049254","PANTOPRAZOLE","40MG","30","Select","Select",""],["","00591024105","LORAZEPAM","1MG","1","Select","Select",""],["","29300022019","MONTELUKAST","10MG","30","Select","Select",""],["","49035049101","PAIN","325MG","30","Select","Select",""],["","49035052378","ACETAMINOPHN","325MG","30","Select","Select",""],["","50111043301","TRAZODONE","50MG","30","Select","Select",""],["","33342009441","RIZATRIPTAN","10MG ODT","9","Select","Select",""],["","68382005105","MELOXICAM","15MG","30","Select","Select",""],["","50383077504","LIDOCAINE","2% VISC","100","Select","Select",""],["","55111014512","FLUCONAZOLE","150MG","2","Select","Select",""],["","00143993905","AMOXICILLIN","500MG","30","Select","Select",""],["","45802013970","METRONIDAZOL","0.75%VAG","70","Select","Select",""],["","43386016106","MISOPROSTOL","200MCG","3","Select","Select",""],["","51672130200","TERCONAZOLE","0.80%","20","Select","Select",""],["","67877022310","GABAPENTIN","300MG","2","Select","Select",""],["","00172392770","DIAZEPAM","10MG","1","Select","Select",""],["","69918030130","TRANEX","650MG","20","Select","Select",""],["","68382004101","PROMETHAZINE","25MG","20","Select","Select",""],["","31722094101","HYDROCO\/APAP","5-325MG","20","Select","Select",""],["","43547028111","ESCITALOPRAM","10MG","30","Select","Select",""],["","59267100001","PFIZER","COVID-19","0","Select","Select",""],["","68645056354","IBUPROFEN","800MG","20","Select","Select",""],["","42806031250","DOXYCYCL","100MG","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","",""],["N\/A","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":""}]}]}