{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"RAYNE   D PATTERSON","gend":1,"add":"9544 5TH BAY ST APT 6","city":"NORFOLK","state":"VA","zip":"23518-9998","dob":"2000-08-24","age":"","mstatus":"","insh":"1176704*01","cliId":"","pno":"757\/650-3291","cno":"","email":"","ename":"","eno":"","pphy":"BASSO, ANA C MD","ppno":"757\/451-0929","pcpadd":"850 KEMPSVILLE RD SUITE 100A","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23502,"pcpcounty":"","pcpid":"","pcpname":"MAWC - Womancare Centers, PLC","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/423-4901","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F33.1","F41.1","F31.31","F43.10","Z62.811","J06.9","N39.0","R10.84","R73.9","L85.8","L70.0","S29.019A","S39.012A","Z68.34","Z30.09","R63.5","F31.81","G44.311","G47.00","R30.0","R39.15","V58.89","F41.9","R51.","V87.7XXA","R11.0","G44.209","J02.9","R11.2","R06.02","J35.1","K11.8","R09.89","Z20.822","Z79.899","R22.0","Z30.431","Z68.29","V23.9","R07.9","N93.9","S46.819A","V49.20XA","Y92.481","Y93.89","Z68.31","Z30.430","M25.562","Z68.30","G44.319","M25.532","M25.512","W10.8XXA","M54.5","R21.","N93.8","R55.","D50.9","R10.31"],"date":["2021-05-13","2021-05-13","2021-03-24","2021-05-13","2021-05-13","2021-12-13","2020-11-16","2020-06-11","2020-06-11","2020-10-02","2020-12-02","2020-09-03","2020-09-03","2020-09-03","2021-07-26","2021-07-26","2020-09-02","2020-09-09","2020-09-09","2020-11-16","2020-11-16","2021-08-15","2021-04-13","2020-06-27","2020-06-27","2020-12-14","2020-12-14","2021-09-16","2021-09-16","2021-09-16","2021-09-16","2021-09-16","2021-09-16","2021-09-16","2021-09-16","2021-09-16","2019-03-04","2019-05-14","2019-01-01","2019-03-18","2019-03-18","2019-05-02","2019-05-02","2019-05-02","2019-05-02","2019-10-10","2019-02-04","2019-02-22","2019-06-18","2019-06-19","2019-06-19","2019-06-19","2019-06-19","2019-05-02","2019-02-06","2019-03-18","2019-03-18","2019-03-18","2019-08-20"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}}]},{"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":[]},{"a":[]},{"a":{"indx":[false,false],"comment":["",""],"score":["",""]}},{"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":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","68462011944","FLUCONAZOLE","TAB 150MG","2","Select","Select",""],["","","HYDROXYZ","TAB 10MG","","Select","Select",""],["","00093005301","BUSPIRONE","TAB 5MG","180","Select","Select",""],["","55111015330","ONDANSETRON","TAB 4MG","20","Select","Select",""],["","67877032105","IBUPROFEN","TAB 800MG","40","Select","Select",""],["","50428032547","SORE","LOZ 15-2.6MG","18","Select","Select",""],["","68180016011","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","65862001230","SERTRALINE","TAB 50MG","30","Select","Select",""],["","67877021901","CEPHALEXIN","CAP 500MG","28","Select","Select",""],["","","PHENAZOPYRID","TAB 200MG","","Select","Select",""],["","","NITROFURANTN","CAP 100MG","","Select","Select",""],["","","SMZ\/TMP","TAB 800-160","","Select","Select",""],["","","APAP\/CODEINE","TAB 300-30MG","","Select","Select",""],["","","METROCREAM","CRE 0.0075","","Select","Select",""],["","","PREDNISONE","TAB 20MG","","Select","Select",""],["","","METRONIDAZOL","CRE 0.0075","","Select","Select",""],["","","DICLOFENAC","TAB 75MG DR","","Select","Select",""],["","","METHYLPRED","TAB 4MG","","Select","Select",""],["","10702000750","CYCLOBENZAPR","TAB 10MG","12","Select","Select",""],["","","BUT\/APAP\/CAF","CAP CODEINE","","Select","Select",""],["","","METHOCARBAM","TAB 500MG","","Select","Select",""],["","","ROSADAN","CRE 0.0075","","Select","Select",""],["","00023520690","ACZONE","GEL 0.075","90","Select","Select",""],["","00472012645","ADAPALENE","GEL 0.003","45","Select","Select",""],["","00299591845","DIFFERIN","GEL 0.003","45","Select","Select",""],["","65862037401","ESCITALOPRAM","TAB 10MG","30","Select","Select",""],["","43547034703","PAROXETINE","TAB 10MG","30","Select","Select",""],["","60258015001","SF","CRE 0.011","51","Select","Select",""],["","45802006436","TRIAMCINOLON","CRE 0.001","80","Select","Select",""],["","11822010233","PAIN","TAB 500MG","80","Select","Select",""],["","00472011745","TRETINOIN","CRE 0.00025","45","Select","Select",""],["","68462019001","NAPROXEN","TAB 500MG","20","Select","Select",""]]}},{"a":[]},{"a":[]},{"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":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":[]}]},{"t":"Mini-Cog","q":[{"a":[]},{"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":"","a13":""}]}]}