{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CHANTEL   N MULHEARN","gend":1,"add":"3816 KEELBOAT CIR APT 201","city":"VIRGINIA BEACH","state":"VA","zip":"23453-9998","dob":"1983-08-31","age":"","mstatus":"","insh":"1732631*01","cliId":"","pno":"757\/355-3729","cno":"","email":"","ename":"","eno":"","pphy":"LI, WENHONG MD","ppno":"757\/689-8430","pcpadd":"SUITE 100 1925 GLENN MITCHELL DR","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23456,"pcpcounty":"","pcpid":"","pcpname":"Princess Anne Medical Associates","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/689-8435","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M51.26","M54.16","M54.5","M50.20","M54.12","M54.2","M54.6","M25.561","M25.562","Z79.899","M25.571","M25.572","F34.1","F60.3","F33.1","F41.1","NO DATA","M47.817","M47.812","G47.00","M46.1","K59.00","K21.9","M53.3","Z01.419","Z30.41","L65.9","R63.5","Z86.32","Z72.0","F17.219","J06.9","Z04.1","V49.40XA","T40.2X1A","M47.816","F17.299","E66.9","G89.29","J18.9","M79.2","S93.492A","R41.82","U07.1","R10.2","N64.52","Z32.02","Z13.32","T14.90XA","R69.","T40.601A","R40.20","R73.9","R00.0","G93.40","E87.6","E83.42","Z99.11","M54.42","M54.41","F17.200","M79.605","M79.7","F17.210","F41.8","Z79.891","M62.838","G62.9","R07.9","S61.012A","Z23.","Z51.89","T40.1X1A","S90.32XA","T42.4X1A","R40.4","D72.829","F41.9","F31.9","F19.10","Z78.1","R52.","J96.00","T42.4X4A","T40.2X4A","S99.912A","T43.621A","R73.03"],"date":["2021-11-22","2021-11-22","2021-09-22","2021-11-22","2021-11-22","2021-11-22","2021-11-22","2021-11-22","2021-11-22","2021-11-22","2021-11-22","2021-11-22","2021-07-20","2021-07-20","2021-12-10","2021-12-10","2021-11-22","2019-01-08","2019-07-01","2020-07-20","2020-02-18","2019-11-11","2019-11-11","2020-02-10","2021-11-16","2019-05-28","2019-05-28","2019-05-28","2019-05-28","2020-07-30","2020-07-30","2021-12-29","2021-03-03","2021-03-03","2021-03-16","2019-07-01","2019-07-01","2019-07-01","2019-07-01","2020-04-01","2020-02-11","2020-10-31","2021-03-16","2021-08-14","2021-11-16","2021-11-16","2021-11-16","2021-11-16","2021-03-03","2021-03-03","2021-03-17","2021-03-15","2021-03-15","2021-03-15","2021-03-16","2021-03-16","2021-03-16","2021-03-17","2021-10-25","2021-10-25","2021-10-25","2021-10-25","2019-03-14","2021-12-10","2019-03-14","2019-03-14","2019-06-17","2019-06-17","2019-06-17","2020-04-02","2020-03-28","2020-04-02","2021-03-15","2021-03-15","2021-03-15","2021-03-15","2021-03-15","2021-03-15","2021-03-15","2021-03-15","2021-03-15","2019-06-06","2021-03-16","2021-03-16","2021-03-16","2020-10-31","2021-03-15","2020-06-29"],"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":[["","57237007710","ONDANSETRON","TAB 4MG ODT","12","Select","Select",""],["","29300011416","LAMOTRIGINE","TAB 200MG","30","Select","Select",""],["","68462012605","GABAPENTIN","TAB 600MG","120","Select","Select",""],["","","CYCLOBENZAPR","TAB 10MG","","Select","Select",""],["","65862019301","FLUOXETINE","CAP 20MG","30","Select","Select",""],["","00115180401","HYDROXYZ","CAP 50MG","60","Select","Select",""],["","68382013805","TOPIRAMATE","TAB 25MG","60","Select","Select",""],["","69097052444","DICLOFENAC","GEL 0.01","400","Select","Select",""],["","00406012505","HYDROCO\/APAP","TAB 10-325MG","90","Select","Select",""],["","00536408501","PRENATAL","TAB 28-0.8MG","30","Select","Select",""],["","","IBUPROFEN","TAB 800MG","","Select","Select",""],["","67877024801","QUETIAPINE","TAB 400MG","30","Select","Select",""],["","42806040021","METHYLPRED","TAB 4MG","21","Select","Select",""],["","67877054360","CEFDINIR","CAP 300MG","14","Select","Select",""],["","55111018015","TIZANIDINE","TAB 4MG","90","Select","Select",""],["","69238117109","DOXEPIN","CAP 50MG","30","Select","Select",""],["","51672302002","LIDOCAINE","OIN 0.05","60","Select","Select",""],["","","BENZONATATE","CAP 100MG","","Select","Select",""],["","00143314205","DOXYCYCL","CAP 100MG","20","Select","Select",""],["","68382050010","OMEPRAZOLE","CAP 40MG","60","Select","Select",""],["","00378727253","NORETHINDRON","TAB 0.35MG","28","Select","Select",""],["","","MELOXICAM","TAB 7.5MG","","Select","Select",""],["","","PERCOGESIC","TAB 12.5-325","","Select","Select",""],["","45802046564","KETOCONAZOLE","SHA 0.02","120","Select","Select",""],["","63481068447","VOLTAREN","GEL 0.01","500","Select","Select",""],["","00781714219","ADAPALENE","GEL 0.003","45","Select","Select",""],["","00527133701","BACLOFEN","TAB 20MG","90","Select","Select",""],["","00591544210","PREDNISONE","TAB 10MG","42","Select","Select",""],["","59310057922","PROAIR","AER ","8","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":""}]}]}