{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MEGAN   W WARD","gend":1,"add":"2500 NUMBER TEN LN TRLR 7","city":"CHESAPEAKE","state":"VA","zip":"23323-9998","dob":"1987-07-07","age":"","mstatus":"","insh":"3655172*01","cliId":"","pno":"757\/324-0505","cno":"757\/324-0505","email":"","ename":"","eno":"","pphy":"SHICK, DEVON MD","ppno":"757\/842-6180","pcpadd":"SUITE 101 1419 CEDAR ROAD","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":23322,"pcpcounty":"","pcpid":146583,"pcpname":"Cedar Road Medical Associates","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"757\/839-9784","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/842-6181","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R87.612","Z32.02","F41.9","F32.2","F41.0","F33.1","K21.9","M54.5","L70.9","G89.29","V62.84","F99.","F11.23","F15.23","L02.412","F10.239","F17.210","M25.571","R60.0","F11.20","L03.90","R51.9","R53.83","M79.671","M79.673","E78.5","F10.20","S01.511A","W54.0XXA","S01.551A","F10.920","NO DATA","R00.0","E11.9","I10.","E07.9","Z87.891","R61."],"date":["2020-04-20","2020-04-20","2021-11-09","2020-09-03","2020-09-03","2020-09-16","2020-08-13","2020-08-13","2020-08-13","2020-08-13","2021-08-26","2021-08-26","2021-09-03","2021-08-27","2021-08-27","2021-08-27","2021-08-27","2021-08-27","2021-09-01","2021-09-21","2021-08-28","2021-08-28","2021-11-09","2021-08-28","2021-09-02","2021-09-01","2021-09-03","2021-10-21","2021-10-21","2021-10-18","2021-10-18","2021-11-09","2021-11-09","2021-11-09","2021-11-09","2021-11-09","2021-11-09","2021-11-09"],"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":[["","16729013616","CLONAZEPAM ","0.5MG","20","Select","Select",""],["","55111015930","OMEPRAZOLE ","40MG","30","Select","Select",""],["","43547034711","PAROXETINE ","10MG","60","Select","Select",""],["","16714008210","HYDROXYZ ","25MG","30","Select","Select",""],["","10702000709","CYCLOBENZAPR ","10MG","30","Select","Select",""],["","16714035101","FLUOXETINE ","10MG","30","Select","Select",""],["","50111043301","TRAZODONE ","50MG","30","Select","Select",""],["","55111015930","OMEPRAZOLE","40MG","30","Select","Select",""],["","16729013616","CLONAZEPAM","0.5MG","20","Select","Select",""],["","16714008210","HYDROXYZ","25MG","30","Select","Select",""],["","10702000709","CYCLOBENZAPR","10MG","30","Select","Select",""],["","43547034711","PAROXETINE","10MG","60","Select","Select",""],["","16714035101","FLUOXETINE","10MG","30","Select","Select",""],["","50111043301","TRAZODONE","50MG","30","Select","Select",""],["","67877021905","CEPHALEXIN","500MG","20","Select","Select",""],["","47781035703","BUPREN\/NALOX","8-2MG","28","Select","Select",""],["","12496120803","SUBOXONE","8-2MG","14","Select","Select",""],["","59746000103","METHYLPRED","4MG","21","Select","Select",""],["","70010000201","COLCHICINE","0.6MG","9","Select","Select",""],["","69547035302","NARCAN","","2","Select","Select",""],["","65162010211","GABAPENTIN","300MG","42","Select","Select",""],["","00093406701","PRAZOSIN","1MG","7","Select","Select",""],["","31722000290","VENLAFAXINE","37.5 ER","7","Select","Select",""],["","50111078751","AZITHROMYCIN","250MG","6","Select","Select",""],["","31722000290","VENLAFAXINE ","CAP 37.5 ER","7","Select","Select",""],["","65162010211","GABAPENTIN ","CAP 300MG","42","Select","Select",""],["","00093406701","PRAZOSIN ","CAP 1MG","7","Select","Select",""],["","47781035703","BUPREN\/NALOX ","MIS 8-2MG","14","Select","Select",""],["","70010000201","COLCHICINE ","TAB 0.6MG","9","Select","Select",""],["","67877021905","CEPHALEXIN ","CAP 500MG","20","Select","Select",""],["","69547035302","NARCAN ","SPR ","2","Select","Select",""],["","12496120803","SUBOXONE ","MIS 8-2MG","28","Select","Select",""],["","42571016142","AMOX\/K ","TAB 500-125","20","Select","Select",""],["","50111078751","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","59746000103","METHYLPRED ","TAB 4MG","21","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","",""],["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":""}]}]}