{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"FRANCISCA  R MIDGETTE","gend":1,"add":"1229 STRAND ST APT F","city":"NORFOLK","state":"VA","zip":"23513-9998","dob":"1997-12-05","age":"","mstatus":"","insh":"9704256*01","cliId":"","pno":"757\/752-5120","cno":"757\/752-5120","email":"","ename":"","eno":"","pphy":"BEVERLY, VERNIS MD","ppno":"757\/484-2001","pcpadd":"STE A 3800 POPLAR HILL RD","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":23321,"pcpcounty":"","pcpid":128565,"pcpname":"Adult and Pediatric Medical Associates","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/484-2182","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M54.2","F17.290","R11.0","K21.9","O21.0","Z33.1","O21.9","Z3A.11","Z3A.12","V23.9","Z3A.34","Z23.","R11.2","N92.6","O99.824","Z37.0","O99.62","K59.00","K46.9","Z30.017","Z20.822","Z3A.38","Z88.8","Z91.040","Z82.49","Z34.83","Z30.46","Z30.018","Z30.09","Z34.82","Z3A.16","O80.","O47.9","Z3A.25"],"date":["2020-01-12","2020-01-12","2020-09-09","2020-09-09","2021-04-13","2020-09-28","2021-03-15","2020-09-28","2020-10-13","2021-03-15","2021-03-15","2021-04-13","2020-08-26","2020-02-19","2021-04-13","2021-04-13","2021-04-13","2021-04-13","2021-04-13","2021-04-15","2021-04-13","2021-04-13","2021-04-13","2021-04-13","2021-04-13","2021-04-13","2020-02-25","2020-02-25","2020-02-25","2020-11-10","2020-11-10","2021-04-13","2021-01-09","2021-01-09"],"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":[["","45802004835","NYSTATIN ","100000","15","Select","Select",""],["","45802093716","HYDROCORT ","2.50%","59","Select","Select",""],["","65862039010","ONDANSETRON ","4MG ODT","30","Select","Select",""],["","39328010610","PRENATAL ","27-1MG","30","Select","Select",""],["","68382004101","PROMETHAZINE ","25MG","30","Select","Select",""],["","00781286810","OMEPRAZOLE ","20MG","30","Select","Select",""],["","54629060099","DOCUSATE ","100MG","30","Select","Select",""],["","11822003960","RA ","100MG","60","Select","Select",""],["","80681013800","CALCIUM\/D3 ","600MG","60","Select","Select",""],["","00904759080","FEROSUL ","325MG","30","Select","Select",""],["","65162046650","IBUPROFEN ","800MG","30","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","",""],["No","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":""}]}]}