{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JESSICA RIVERS","gend":1,"add":"14547 OLD COURTHOUSE WAY UNIT B","city":"NEWPORT NEWS","state":"VA","zip":"23608-9998","dob":"1987-01-20","age":"","mstatus":"","insh":"1903191*01","cliId":"","pno":"757\/660-4162","cno":"","email":"","ename":"","eno":"","pphy":"HAMID, KHALID MD","ppno":"757\/874-8400","pcpadd":"15425-H WARWICK BLVD","pcpcity":"NEWPORT NEWS","pcpstate":"VA","pcpzip":23607,"pcpcounty":"","pcpid":"","pcpname":"PENINSULA INSTITUTE FOR COMMUNITY HEALTH","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/947-2001","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["A41.9","N12.","G43.909","I10.","J02.9","K31.84","B96.20","Z90.710","R07.89","R51.","R20.2","J01.90","G43.809","B96.89","S63.591A","S60.211A","Y93.01","W23.1XXA","Y92.010","S62.615A","M79.645","Z51.89","Z79.899","Z88.6","S63.635A","N39.0","B37.0","R11.0","R07.9","R59.1","S62.603A","M79.7","S69.92XS","NO DATA","S40.021A","M79.642","M62.838","R00.0","Z13.220","R82.90","V54.12","E87.6","Z87.81","A59.00","R10.13","L03.114","J20.9","Z09.","Z87.448","Z86.19","M79.674","Z53.21","R61.","R10.9","S62.605A","S62.613A","S62.625A","G89.18","R70.0","Z79.1"],"date":["2019-09-20","2019-09-20","2021-12-07","2021-12-29","2019-09-24","2019-09-20","2019-09-20","2019-09-20","2019-10-02","2020-01-29","2019-10-30","2020-03-26","2020-03-26","2020-03-26","2021-02-23","2021-02-23","2021-02-23","2021-02-23","2021-02-23","2021-09-20","2021-12-29","2021-10-24","2021-12-07","2021-12-29","2021-12-29","2019-09-20","2019-09-24","2019-09-24","2020-01-24","2020-01-29","2021-09-25","2021-10-04","2021-10-04","2021-11-02","2019-11-25","2021-11-16","2021-04-13","2021-04-13","2021-04-13","2021-04-13","2021-10-30","2021-11-16","2021-11-16","2020-01-24","2020-01-24","2021-12-19","2019-03-09","2019-09-24","2019-09-24","2019-09-24","2021-05-29","2021-12-29","2019-09-18","2019-09-25","2021-10-04","2021-10-05","2021-10-05","2021-12-07","2021-12-07","2021-12-07"],"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":[["","71930005612","APAP\/CODEINE","TAB 300-60MG","40","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","15","Select","Select",""],["","00591565810","CYCLOBENZAPR","TAB 10MG","21","Select","Select",""],["","69584061250","METHOCARBAM","TAB 750MG","12","Select","Select",""],["","53746010901","HYDROCO\/APAP","TAB 5-325MG","7","Select","Select",""],["","00406055201","OXYCODONE","TAB 5MG","16","Select","Select",""],["","","TRAMADOL","TAB 50MG","","Select","Select",""],["","42858010201","OXYCOD\/APAP","TAB 5-325MG","12","Select","Select",""],["","","LOSARTAN"," LOSARTAN ","30","Select","Select",""],["","68462010530","ONDANSETRON","TAB 4MG","21","Select","Select",""],["","10702000350","PROMETHAZINE","TAB 25MG","15","Select","Select",""],["","43547030403","ARIPIPRAZOLE","TAB 10MG","15","Select","Select",""],["","69547035302","NARCAN","SPR ","2","Select","Select",""],["","80681002900","CALCIUM\/D3","TAB 600-400","60","Select","Select",""],["","00093031401","KETOROLAC","TAB 10MG","10","Select","Select",""],["","59779019780","IBUPROFEN","CAP 200MG","60","Select","Select",""],["","59779054462","ARTHRTS","TAB 650MG","120","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","20","Select","Select",""],["","","PROPRANOLOL"," PROPRANOLOL ","30","Select","Select",""],["","69097081312","GABAPENTIN","CAP 100MG","30","Select","Select",""],["","","AZITHROMYCIN","TAB 250MG","","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":""}]}]}