{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"WHITNEY KOSLOSKE","gend":1,"add":"3419 W WEAVER AVE APT 20","city":"HAMPTON","state":"VA","zip":"23666-9998","dob":"1991-10-16","age":"","mstatus":"","insh":"4377702*01","cliId":"","pno":"757\/508-6143","cno":"757\/508-6143","email":"","ename":"","eno":"","pphy":"STAPLETON, MACY LERIN NP","ppno":"757\/838-8166","pcpadd":"2101 EXECUTIVE DRIVE SUITE 160","pcpcity":"HAMPTON","pcpstate":"VA","pcpzip":23666,"pcpcounty":"","pcpid":209199,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["A41.9","K80.50","K85.10","K21.9","R10.2","R10.84","R11.2","R19.7","Z71.89","Z98.890","D64.9","E66.01","Z68.41","F41.9","R61.","Z86.39","Z87.891","F41.0","E03.9","Z90.49","Z87.442","R93.89","K85.90","K80.12","R10.33","R10.812","R10.811","R10.9","R50.9","G89.18","R10.10","R74.0","N39.0","J98.11","N83.202","N76.0","B96.89","K80.65","F32.9","N83.292","R10.32","K62.89","R03.0","N93.9","K08.9","Z20.828","J03.90","R03.1"],"date":["2020-05-27","2020-05-27","2020-05-27","2020-11-10","2021-04-22","2020-05-28","2020-05-23","2020-05-23","2020-06-04","2020-06-04","2020-10-27","2020-11-18","2020-11-18","2020-11-18","2020-06-04","2020-11-18","2020-11-18","2020-11-10","2020-11-10","2020-11-10","2020-11-10","2021-02-09","2020-05-25","2020-05-26","2021-04-22","2021-04-22","2021-04-22","2020-05-24","2020-05-28","2020-05-28","2020-05-23","2020-05-24","2020-05-24","2020-05-28","2021-04-22","2021-04-22","2021-04-22","2020-05-23","2020-05-23","2020-10-27","2020-10-27","2020-10-27","2020-10-27","2020-11-17","2020-12-28","2020-12-28","2020-12-28","2021-02-09"],"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":[["","00406052301","OXYCOD\/APAP ","10-325MG","18","Select","Select",""],["","00115180301","HYDROXYZ ","25MG","30","Select","Select",""],["","64380080707","IBUPROFEN ","800MG","20","Select","Select",""],["","65862001705","AMOXICILLIN ","500MG","30","Select","Select",""],["","69315090405","LORAZEPAM ","0.5MG","10","Select","Select",""],["","00172572960","FAMOTIDINE ","40MG","15","Select","Select",""],["","42571016201","AMOX\/K ","875-125","10","Select","Select",""],["","53746010901","HYDROCO\/APAP ","5-325MG","15","Select","Select",""],["","69547035302","NARCAN ","","2","Select","Select",""],["","69238183007","LEVOTHYROXIN ","25MCG","90","Select","Select",""],["","00904759080","FEROSUL ","325MG","90","Select","Select",""],["","65862001105","SERTRALINE ","25MG","30","Select","Select",""],["","11917009215","FERROUS ","325MG","90","Select","Select",""],["","50383077504","LIDOCAINE ","2% VISC","100","Select","Select",""],["","00406052301","OXYCOD\/APAP","10-325MG","18","Select","Select",""],["","53746010901","HYDROCO\/APAP","5-325MG","15","Select","Select",""],["","69315090405","LORAZEPAM","0.5MG","10","Select","Select",""],["","00115180301","HYDROXYZ","25MG","30","Select","Select",""],["","42571016201","AMOX\/K","875-125","10","Select","Select",""],["","69547035302","NARCAN","","2","Select","Select",""],["","64380080707","IBUPROFEN","800MG","20","Select","Select",""],["","65862001705","AMOXICILLIN","500MG","30","Select","Select",""],["","65862001105","SERTRALINE","25MG","30","Select","Select",""],["","69238183007","LEVOTHYROXIN","25MCG","90","Select","Select",""],["","11917009215","FERROUS","325MG","90","Select","Select",""],["","00904759080","FEROSUL","325MG","90","Select","Select",""],["","50383077504","LIDOCAINE","2% VISC","100","Select","Select",""],["","00172572960","FAMOTIDINE","40MG","15","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":""}]}]}