{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TERESA   A BIVINS-CAINE","gend":1,"add":"1653 NORTH MAIN ST","city":"NEWPORT NEWS","state":"VA","zip":"23605-9998","dob":"2003-10-16","age":"","mstatus":"","insh":"9829997*01","cliId":"","pno":"757\/726-3841","cno":"757\/726-3841","email":"","ename":"","eno":"","pphy":"OMOJI, BASSEY MD","ppno":"434\/793-7745","pcpadd":"SUITE B 140 PINEY FOREST RD","pcpcity":"DANVILLE","pcpstate":"VA","pcpzip":24540,"pcpcounty":"","pcpid":105919,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"434\/299-3389","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R10.9","R07.89","M79.672","R10.32","F33.1","F41.1","J40.","N39.0","B96.89","R50.81","R50.9","R06.02","H16.011","H16.001","N30.01","Z32.02","B96.20","R10.33","R11.2","V62.84","R52.","K11.21","R07.9","Z91.5","N92.0","R22.0","K11.20","J02.9","B00.2","Z02.2","Z91.018","J45.20","J30.2","N94.6","N30.90","F43.23","R51.9","Y04.8XXA","Y92.019","F34.81","F91.3","R10.84","R11.0","S09.90XA","S86.912A","K52.9","R19.7","S93.402A","R10.11","K59.00","D64.9","M25.562","F31.9","J11.1","R05.","V58.89","R69.","T14.90XA","S89.92XA","S69.92XA"],"date":["2020-07-06","2020-10-24","2021-02-27","2021-02-24","2021-08-31","2021-08-31","2020-01-12","2021-01-21","2020-01-12","2020-01-12","2020-01-12","2020-01-13","2020-04-26","2020-06-12","2021-04-26","2020-11-06","2020-12-26","2020-12-26","2021-04-26","2021-01-21","2020-08-02","2020-08-03","2020-10-24","2021-01-21","2020-07-06","2021-01-29","2020-08-02","2021-01-29","2021-01-29","2021-01-29","2021-01-29","2021-06-18","2021-01-29","2021-01-29","2021-01-29","2021-02-05","2021-02-27","2021-02-27","2021-02-27","2021-03-02","2021-03-02","2021-04-26","2021-04-26","2021-05-27","2021-05-27","2021-02-24","2021-02-24","2021-02-27","2021-05-16","2021-05-16","2021-05-16","2021-09-08","2021-06-18","2020-01-08","2020-01-08","2021-08-12","2021-05-27","2021-05-27","2021-08-30","2021-09-01"],"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":[["","00085113204","PROVENTIL ","HFA","7","Select","Select",""],["","00254100752","ALBUTEROL ","HFA","7","Select","Select",""],["","68180012202","CEPHALEXIN ","500MG","14","Select","Select",""],["","00065064835","TOBRADEX ","0.3-0.1%","4","Select","Select",""],["","65862018601","CLINDAMYCIN ","300MG","30","Select","Select",""],["","61314064705","TOBRA\/DEXAME ","0.3-0.1%","5","Select","Select",""],["","69315030805","CIPROFLOXACN ","0.3% OP","5","Select","Select",""],["","61314063006","NEO\/POLY\/DEX ","0.1% OP","5","Select","Select",""],["","13668021730","ARIPIPRAZOLE ","5MG","30","Select","Select",""],["","65862077885","TRI-LO-MILI ","","28","Select","Select",""],["","00143122701","DICYCLOMINE ","20MG","30","Select","Select",""],["","63304061650","DOXYCYC ","100MG","14","Select","Select",""],["","59746000103","METHYLPRED ","4MG","21","Select","Select",""],["","00143924920","AMOX\/K ","875-125","20","Select","Select",""],["","45802075830","PROMETHAZINE ","12.5MG","12","Select","Select",""],["","68645052154","SERTRALINE ","25MG","30","Select","Select",""],["","65162047810","NITROFURANTN ","100MG","10","Select","Select",""],["","45802065087","LORATADINE ","10MG","30","Select","Select",""],["","57896020110","PAIN ","500MG","30","Select","Select",""],["","68645056259","IBUPROFEN ","600MG","30","Select","Select",""],["","57237007710","ONDANSETRON ","4MG ODT","20","Select","Select",""],["","81131031250","MELATONIN ","3MG","30","Select","Select",""],["","49035048462","ACETAMINOPHN ","500MG","30","Select","Select",""],["","49035061246","ALLERGY ","10MG","30","Select","Select",""],["","65162019011","NAPROXEN ","500MG","10","Select","Select",""],["","00093598627","EPINEPHRINE ","0.3MG","2","Select","Select",""],["","69452014320","BENZONATATE ","100MG","21","Select","Select",""],["","31722063231","OSELTAMIVIR ","75MG","10","Select","Select",""],["","31722063231","OSELTAMIVIR","75MG","10","Select","Select",""],["","00085113204","PROVENTIL","HFA","7","Select","Select",""],["","69452014320","BENZONATATE","100MG","21","Select","Select",""],["","00254100752","ALBUTEROL","HFA","7","Select","Select",""],["","68180012202","CEPHALEXIN","500MG","14","Select","Select",""],["","69315030805","CIPROFLOXACN","0.3% OP","5","Select","Select",""],["","00065064835","TOBRADEX","0.3-0.1%","4","Select","Select",""],["","61314063006","NEO\/POLY\/DEX","0.1% OP","5","Select","Select",""],["","61314064705","TOBRA\/DEXAME","0.3-0.1%","5","Select","Select",""],["","65862077885","TRI-LO-MILI","","28","Select","Select",""],["","59746000103","METHYLPRED","4MG","21","Select","Select",""],["","65862018601","CLINDAMYCIN","300MG","30","Select","Select",""],["","00143924920","AMOX\/K","875-125","20","Select","Select",""],["","65162047810","NITROFURANTN","100MG","10","Select","Select",""],["","57896020110","PAIN","500MG","30","Select","Select",""],["","65162089703","ARIPIPRAZOLE","5MG","30","Select","Select",""],["","81131031250","MELATONIN","3MG","30","Select","Select",""],["","45802065078","LORATADINE","10MG","30","Select","Select",""],["","68645056259","IBUPROFEN","600MG","30","Select","Select",""],["","68382004001","PROMETHAZINE","12.5MG","12","Select","Select",""],["","49035061246","ALLERGY","10MG","30","Select","Select",""],["","00143122701","DICYCLOMINE","20MG","30","Select","Select",""],["","63304061650","DOXYCYC","100MG","14","Select","Select",""],["","49035048462","ACETAMINOPHN","500MG","30","Select","Select",""],["","57237007710","ONDANSETRON","4MG ODT","20","Select","Select",""],["","68645052154","SERTRALINE","25MG","30","Select","Select",""],["","65162019011","NAPROXEN","500MG","10","Select","Select",""],["","00093598627","EPINEPHRINE","0.3MG","2","Select","Select",""],["","00054001925","PREDNISONE","50MG","5","Select","Select",""],["","00904530660","BANOPHEN","25MG","20","Select","Select",""],["","59310057922","PROAIR","","17","Select","Select",""],["","50111033402","METRONIDAZOL","500MG","14","Select","Select",""],["","50580022824","BENADRYL","25MG","20","Select","Select",""],["","10702001606","INDOMETHACIN","75MG ER","10","Select","Select",""],["","00555901858","TRI-SPRINTEC","","28","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":""}]}]}