{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JOANNA   C ADAMOV","gend":1,"add":"104 WITCH DUCK ROAD APT B","city":"VIRGINIA BEACH","state":"VA","zip":"23452-9998","dob":"1977-03-15","age":"","mstatus":"","insh":"1449925*01","cliId":"","pno":"757\/977-7286","cno":"757\/275-3071","email":"","ename":"","eno":"","pphy":"ELHASSAN, AMIRA S MD","ppno":"757\/738-1300","pcpadd":"4421 VIRGINIA BEACH BLVD STE 114","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23462,"pcpcounty":"","pcpid":"","pcpname":"BON SECOURS MEDICAL ASSOCIATES","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/687-3202","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R10.13","K21.9","R63.4","R11.2","F43.10","Z20.2","F41.1","F31.9","Z72.0","Z68.25","R87.610","N81.10","F17.200","Z85.41","Z20.822","E27.8","R23.8","NO DATA","Q61.02","R42.","I95.9","R52.","F41.9","R68.81","Z00.00","F17.210","K58.0","Z12.4","Z12.31","H16.223","R87.629","H04.123","M79.7","R53.83","K21.0","E87.6","F32.1","N99.3","N81.89","N39.46","M25.552","R55.","D17.79","T14.8XXA","N20.0","Z01.812","R07.89","M77.8","L03.031","L60.0","B35.1","Z20.828","R31.9","R60.0","M24.80","M51.36","M79.671","J41.8","M79.672","G89.29","R93.89","R94.31","R68.89","R10.2","N89.8","J98.4","R25.9","G25.3","R41.840","R41.3","G25.0","R29.810","M25.511","V89.2XXD","M62.838","M54.6","R51.9","R10.12","Z86.010"],"date":["2022-11-18","2021-06-29","2021-06-29","2021-06-29","2022-06-03","2021-11-23","2021-11-23","2022-06-03","2022-10-03","2021-11-23","2021-02-22","2021-03-30","2021-02-22","2021-02-22","2021-03-29","2021-07-30","2021-07-30","2022-11-03","2022-06-03","2021-07-30","2021-07-30","2021-07-30","2020-10-08","2021-01-05","2021-01-08","2021-01-08","2022-11-18","2021-01-08","2021-01-08","2021-02-04","2021-01-08","2021-05-12","2021-05-12","2021-05-12","2020-08-17","2020-08-17","2020-08-17","2021-03-30","2021-03-30","2021-03-30","2021-10-14","2021-10-14","2021-12-15","2021-12-15","2020-10-14","2021-02-03","2020-07-04","2020-12-03","2020-12-14","2021-01-21","2020-12-21","2021-11-11","2022-06-19","2022-06-19","2022-10-03","2022-10-03","2022-10-03","2022-10-03","2022-10-03","2022-10-03","2022-02-18","2022-02-02","2022-02-02","2022-03-24","2022-03-24","2022-02-18","2022-06-03","2022-11-07","2022-11-07","2022-11-07","2022-11-07","2022-11-07","2022-11-03","2022-11-03","2022-11-03","2022-10-24","2022-10-24","2022-10-24","2022-11-18"],"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":[["","43598044874","NICOTINE","DIS 21MG\/24H","28","Select","Select",""],["","","LAMOTRIGINE","TAB 25MG","","Select","Select",""],["","00527128201","DICYCLOMINE","TAB 20MG","90","Select","Select",""],["","","BUSPIRONE","TAB 10MG","","Select","Select",""],["","51862094105","DIAZEPAM","TAB 2MG","30","Select","Select",""],["","00135019402","NICODERM","DIS 21MG\/24H","28","Select","Select",""],["","50111033402","METRONIDAZOL","TAB 500MG","30","Select","Select",""],["","57237000511","FLUCONAZOLE","TAB 150MG","2","Select","Select",""],["","","CEPHALEXIN","TAB 500MG","","Select","Select",""],["","68180035202","SERTRALINE","TAB 50MG","15","Select","Select",""],["","52817033010","CYCLOBENZAPR","TAB 5MG","60","Select","Select",""],["","65162083366","DICLOFENAC","GEL 0.01","200","Select","Select",""],["","","AMITRIPTYLIN","TAB 10MG","","Select","Select",""],["","69367022001","SOD","TAB 1GM","90","Select","Select",""],["","","PANTOPRAZOLE","TAB 40MG","","Select","Select",""],["","49884030802","CLONAZEP","TAB 0.5MG","21","Select","Select",""],["","16729013616","CLONAZEPAM","TAB 0.5MG","21","Select","Select",""],["","00054418125","DEXAMETHASON","TAB 1MG","1","Select","Select",""],["","","POT  CL MICRO","TAB 20MEQ ER","","Select","Select",""],["","","METOCLOPRAM","TAB 10MG","","Select","Select",""],["","","VENLAFAXINE","CAP 75MG ER","","Select","Select",""],["","","ADDERALL","CAP 15MG","","Select","Select",""],["","","AMPHET\/DEXTR","CAP 15MG ER","","Select","Select",""],["","","SILVER","CRE 0.01","","Select","Select",""],["","","DOXYCYCL","TAB 100MG","","Select","Select",""],["","","SILVADENE","CRE 0.01","","Select","Select",""],["","","SMZ\/TMP","TAB 800-160","","Select","Select",""],["","","HYDROCO\/APAP","TAB 5-325MG","","Select","Select",""],["","","SSD","CRE 0.01","","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":""}]}]}