{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"STACY   L EITNIEAR","gend":1,"add":"2051 E OCEAN VIEW AVE APT 8","city":"NORFOLK","state":"VA","zip":"23503-9998","dob":"1982-10-18","age":"","mstatus":"","insh":"1829762*01","cliId":"","pno":"757\/933-3915","cno":"757\/933-3915","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":["J96.01","J45.901","J18.9","Z20.828","F17.210","S93.492A","K02.9","K04.01","Z88.5","Z88.8","K08.89","Z87.42","Z86.018","Z98.51","N92.6","N91.5","R68.82","L73.2","K04.7","K12.2","L03.211","F12.90","J45.909","R25.2","E78.5","Z79.899","E66.9","Z68.36","F32.9","F41.9","R33.9","M75.41","M75.51","M54.16","I49.9","E78.00","R12.","Z01.411","F43.10","F60.3","F41.1","M54.5","M25.562","M51.16","M47.816","Z71.89","Z71.6","Z71.3","E66.09","Z68.39","E78.2","NO DATA","G89.18","F17.200","G44.209","R19.7","R06.02","R06.89","M51.36","F41.8","M75.42","R51.9","Z20.822","M62.838","M54.2","K29.01","R10.12","R22.0","D18.01","I10.","G89.29","M54.9","Z68.38","R11.0"],"date":["2020-11-21","2020-11-22","2020-11-22","2020-11-19","2022-09-06","2021-07-02","2022-09-06","2022-01-02","2022-09-06","2022-09-06","2022-09-06","2022-01-05","2022-01-05","2022-01-05","2022-01-05","2022-01-05","2022-01-05","2022-02-09","2020-05-26","2020-05-23","2020-05-22","2020-05-22","2022-09-06","2020-05-22","2021-02-25","2022-09-06","2022-06-06","2020-05-22","2020-11-19","2020-11-19","2020-05-22","2020-09-01","2020-09-01","2021-02-25","2021-02-11","2021-02-11","2021-02-11","2021-11-23","2020-11-19","2020-03-10","2020-03-10","2021-02-25","2020-04-27","2021-02-25","2021-02-25","2021-02-11","2021-02-11","2021-02-11","2021-02-25","2021-02-25","2020-05-22","2020-08-06","2020-09-01","2020-11-19","2020-11-19","2020-11-19","2020-11-19","2020-11-19","2021-01-06","2021-02-25","2020-08-10","2021-11-28","2021-11-28","2020-05-18","2020-05-18","2022-06-06","2022-06-06","2022-09-06","2022-02-09","2022-06-06","2022-06-06","2022-06-06","2022-06-06","2022-06-06"],"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":[["","53746061705","TRAMADL\/APAP","TAB 37.5-325","6","Select","Select",""],["","63304069301","CLINDAMYCIN","CAP 300MG","28","Select","Select",""],["","00555087302","MEDROXYPR","TAB 5MG","28","Select","Select",""],["","00116200116","CHLORHEX","SOL 0.0012","473","Select","Select",""],["","16729022601","SPIRONOLACT","TAB 50MG","30","Select","Select",""],["","11822880780","FOLIC","TAB 400MCG","30","Select","Select",""],["","69238153206","CLOBETASOL","CRE 0.0005","60","Select","Select",""],["","29300012410","MELOXICAM","TAB 7.5MG","60","Select","Select",""],["","19903001028","MYLANTA","SUS MAX ST","335","Select","Select",""],["","00172572860","FAMOTIDINE","TAB 20MG","60","Select","Select",""],["","00093310953","AMOXICILLIN","CAP 500MG","30","Select","Select",""],["","66685100101","AMOX\/K","TAB 875-125","20","Select","Select",""],["","31722094101","HYDROCO\/APAP","TAB 5-325MG","9","Select","Select",""],["","69367020301","BUT\/APAP\/CAF","TAB ","24","Select","Select",""],["","60505257808","ATORVASTATIN","TAB 10MG","30","Select","Select",""],["","23155019201","BUPROPION","TAB 100MG","60","Select","Select",""],["","51645070310","ACETAMIN","TAB 325MG","20","Select","Select",""],["","00093031401","KETOROLAC","TAB 10MG","20","Select","Select",""],["","00378110101","PRAZOSIN","CAP 1MG","30","Select","Select",""],["","63402030230","LATUDA","TAB 20MG","60","Select","Select",""],["","52817033200","CYCLOBENZAPR","TAB 10MG","15","Select","Select",""],["","00406051205","OXYCOD\/APAP","TAB 5-325MG","20","Select","Select",""],["","55111015330","ONDANSETRON","TAB 4MG","10","Select","Select",""],["","55111018015","TIZANIDINE","TAB 4MG","90","Select","Select",""],["","00597008717","ATROVENT","AER 17MCG","13","Select","Select",""],["","76204020025","ALBUTEROL","NEB 0.00083","300","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","00054001925","PREDNISONE","TAB 50MG","5","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":""}]}]}