{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LATISHA   M WOODARD","gend":1,"add":"2014 CAMDEN AVE","city":"PORTSMOUTH","state":"VA","zip":"23704-9998","dob":"1982-05-02","age":"","mstatus":"","insh":"7298447*01","cliId":"","pno":"757\/535-3756","cno":"757\/535-3756","email":"","ename":"","eno":"","pphy":"SKINNER, ALISON C MD","ppno":"757\/686-5673","pcpadd":"SUITE 102 3253 TAYLOR ROAD","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":23321,"pcpcounty":"","pcpid":411053,"pcpname":"BON SECOURS WESTERN BRANCH PRIMARY CARE","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/686-8694","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M62.89","K21.9","M54.5","M54.32","N30.00","M54.2","Z68.37","F32.1","F41.9","E55.9","R20.2","M54.6","R06.02","N76.0","N30.01","R35.8","R63.1","E66.9","B96.89","J32.9","J30.1","R05.","Z00.00","R06.83","R53.83","R10.2"],"date":["2020-03-11","2020-03-11","2020-03-27","2020-12-05","2021-04-26","2020-03-27","2020-08-12","2020-10-23","2020-10-23","2020-10-23","2020-03-27","2020-03-27","2020-05-17","2020-06-04","2020-06-04","2020-06-04","2020-06-04","2020-08-12","2020-06-04","2020-01-21","2020-01-21","2020-05-15","2020-08-12","2020-08-12","2020-08-12","2021-06-09"],"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":[["","59651000205","OMEPRAZOLE ","20MG","30","Select","Select",""],["","45802065087","LORATADINE ","10MG","30","Select","Select",""],["","00093031401","KETOROLAC ","10MG","20","Select","Select",""],["","65862042005","SMZ\/TMP ","800-160","20","Select","Select",""],["","10135012310","ACETAMIN ","325MG","20","Select","Select",""],["","00904671960","ACETAMINOPHE ","325MG","20","Select","Select",""],["","16571020150","DICLOFENAC ","75MG DR","20","Select","Select",""],["","13811071910","NITROFURANTN ","100MG","10","Select","Select",""],["","52817033200","CYCLOBENZAPR ","10MG","20","Select","Select",""],["","00406051205","OXYCOD\/APAP ","5-325MG","30","Select","Select",""],["","62559049001","DIPHEN\/ATROP ","2.5MG","8","Select","Select",""],["","00378623101","CITALOPRAM ","10MG","30","Select","Select",""],["","57237007710","ONDANSETRON ","4MG ODT","87","Select","Select",""],["","00603533932","PREDNISONE ","20MG","21","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","69543025216","VIRTUSSIN ","100-10\/5","45","Select","Select",""],["","66993001968","ALBUTEROL ","HFA","18","Select","Select",""],["","50111033402","METRONIDAZOL ","500MG","14","Select","Select",""],["","69452015120","VITAMIN ","50000UNT","12","Select","Select",""],["","58160088552","FLUARIX ","2020-21","0","Select","Select",""],["","00173068220","VENTOLIN ","","18","Select","Select",""],["","51293061201","PHENAZOPYRID ","200MG","6","Select","Select",""],["","64380080807","IBUPROFEN ","600MG","21","Select","Select",""],["","65862018601","CLINDAMYCIN ","300MG","21","Select","Select",""],["","59267100002","PFIZER ","COVID-19","0","Select","Select",""],["","59651000205","OMEPRAZOLE","20MG","30","Select","Select",""],["","65862042005","SMZ\/TMP","800-160","20","Select","Select",""],["","00781507701","LORATADINE","10MG","30","Select","Select",""],["","52817033200","CYCLOBENZAPR","10MG","20","Select","Select",""],["","10135012310","ACETAMIN","325MG","20","Select","Select",""],["","00093031401","KETOROLAC","10MG","20","Select","Select",""],["","00904671960","ACETAMINOPHE","325MG","20","Select","Select",""],["","16571020150","DICLOFENAC","75MG DR","20","Select","Select",""],["","66993001968","ALBUTEROL","HFA","18","Select","Select",""],["","57237007710","ONDANSETRON","4MG ODT","87","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","69543025216","VIRTUSSIN","100-10\/5","45","Select","Select",""],["","13811071910","NITROFURANTN","100MG","10","Select","Select",""],["","50111033402","METRONIDAZOL","500MG","14","Select","Select",""],["","00378623101","CITALOPRAM","10MG","30","Select","Select",""],["","69452015120","VITAMIN","50000UNT","12","Select","Select",""],["","00603533932","PREDNISONE","20MG","21","Select","Select",""],["","58160088552","FLUARIX","2020-21","0","Select","Select",""],["","00173068220","VENTOLIN","","18","Select","Select",""],["","51293061201","PHENAZOPYRID","200MG","6","Select","Select",""],["","64380080807","IBUPROFEN","600MG","21","Select","Select",""],["","65862018601","CLINDAMYCIN","300MG","21","Select","Select",""],["","59267100002","PFIZER","COVID-19","0","Select","Select",""],["","00406051205","OXYCOD\/APAP","5-325MG","30","Select","Select",""],["","62559049001","DIPHEN\/ATROP","2.5MG","8","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":""}]}]}