{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BRITTANY   L ROBINSON","gend":1,"add":"101 SMYTHE CT APT 102","city":"VIRGINIA BEACH","state":"VA","zip":"23452-9998","dob":"1987-11-27","age":"","mstatus":"","insh":"1826971*01","cliId":"","pno":"757\/831-6151","cno":"","email":"","ename":"","eno":"","pphy":"ASUNCION, CHRISTOPHER W MD","ppno":"757\/705-5265","pcpadd":"828 HEALTHY WAY","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23462,"pcpcounty":"","pcpid":"","pcpname":"Mid-Atlantic Family Medicine","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/962-2884","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["B37.3","R30.9","L70.0","L72.9","Z71.9","N30.00","N93.9","Z87.891","F90.0","F41.1","M79.662","N92.6","F32.9","M25.511","N92.0","S90.111A","L90.5","F41.9","B34.9","H69.93","J02.9","Z20.828","R10.9","R07.0","R10.2","Z11.3","Z00.00","M54.5","H04.123","Z23."],"date":["2020-12-28","2021-01-26","2021-05-19","2021-09-02","2021-09-02","2021-01-19","2021-01-19","2021-01-19","2022-09-15","2021-08-19","2021-08-19","2021-08-19","2021-08-19","2021-11-17","2021-11-17","2020-08-11","2021-09-02","2021-12-30","2021-12-30","2022-03-30","2021-02-22","2020-09-28","2020-10-07","2022-02-25","2021-01-20","2021-01-20","2022-09-15","2021-05-19","2022-11-21","2022-09-15"],"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":[]},{"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":[["","00555097302","AMPHET\/DEXTR","TAB 20MG","75","Select","Select",""],["","00406051205","OXYCOD\/APAP","TAB 5-325MG","20","Select","Select",""],["","68462072029","DROSPIRENONE","TAB ETHY EST","84","Select","Select",""],["","65862001705","AMOXICILLIN","CAP 500MG","20","Select","Select",""],["","00378808245","TRETINOIN","CRE 0.00025","45","Select","Select",""],["","42806040021","METHYLPRED","TAB 4MG","21","Select","Select",""],["","68462010630","ONDANSETRON","TAB 8MG","12","Select","Select",""],["","69452015120","VITAMIN","CAP 50000UNT","4","Select","Select",""],["","45802056201","CLINDAMYCIN","SOL 0.01","30","Select","Select",""],["","00093314705","CEPHALEXIN","CAP 500MG","12","Select","Select",""],["","24208091055","ERYTHROMYCIN","OIN 5MG\/GM","4","Select","Select",""],["","00781808926","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","49884072703","DOXYCYC","CAP 100MG","60","Select","Select",""],["","31722093432","DROSPIR\/ETHI","TAB 3-0.02MG","28","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","14","Select","Select",""],["","60846050201","PYRIDIUM","TAB 200MG","9","Select","Select",""],["","57237000511","FLUCONAZOLE","TAB 150MG","2","Select","Select",""],["","65862007701","CIPROFLOXACN","TAB 500MG","14","Select","Select",""],["","51293061201","PHENAZOPYRID","TAB 200MG","9","Select","Select",""],["","70010077001","METHOCARBAM","TAB 750MG","15","Select","Select",""],["","64380078706","BUSPIRONE","TAB 7.5MG","60","Select","Select",""],["","00115166003","PROPRANOLOL","TAB 20MG","45","Select","Select",""],["","68462030929","NORGEST\/ETHI","TAB 0.25\/35","28","Select","Select",""],["","00228202750","ALPRAZOLAM","TAB 0.25MG","10","Select","Select",""],["","57844012001","ADDERALL","TAB 20MG","75","Select","Select",""],["","00591544221","PREDNISONE","PAK 10MG","21","Select","Select",""],["","65162010250","GABAPENTIN","CAP 300MG","120","Select","Select",""],["","53489011802","DOXYCYCL","CAP 50MG","90","Select","Select",""],["","29300012510","MELOXICAM","TAB 15MG","30","Select","Select",""],["","68382013201","TAMSULOSIN","CAP 0.4MG","30","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":""}]}]}