{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KAMILLE MEDINA","gend":1,"add":"924 SANDERLIN LN","city":"VIRGINIA BEACH","state":"VA","zip":"23464-9998","dob":"1987-06-19","age":"","mstatus":"","insh":"1940799*01","cliId":"","pno":"408\/667-7011","cno":"","email":"","ename":"","eno":"","pphy":"SZULC, SUSAN V MD","ppno":"757\/528-2761","pcpadd":"4867 BAXTER RD STE 105","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23462,"pcpcounty":"","pcpid":"","pcpname":"TPMG BEACH PRIMARY CARE","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/937-0435","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F43.23","R20.0","R51.9","R06.2","L30.9","H02.835","F33.2","F31.9","A09.","U07.1","Z68.23","R60.0","R10.84","R11.2","R19.7","R06.00","R10.12","R20.2","R94.02","Z32.02","R87.612","B37.3","J06.9","H60.92","L73.8","L29.9","L81.0","L90.5","Z71.9","Z88.8","Z88.0","Z91.013","Z91.048","R10.13","R14.0","R19.4","J20.9","Z11.59","Z03.818","R06.02","R07.9","Z12.4","N76.0","Z01.419","L72.9","Z23.","Z68.22","F43.21","H54.7","NO DATA","F32.9","V62.84","F41.9","F32.2","F45.0","R68.89","B35.3","F33.0","G31.84","Z30.09","E78.1","Z68.20","F33.1","F09.","M54.2","J40.","R30.0","H60.12","Z00.00","N39.0","E55.9","F41.1","Z30.41","T78.40XA","S83.92XA","N92.5","R10.2","R79.89","M25.562","E11.9","J02.0","Z20.822","H11.152","G93.9","M48.02","M50.21","S86.912A","R87.810"],"date":["2021-07-15","2021-07-15","2021-07-15","2022-01-06","2020-10-30","2020-01-08","2020-04-08","2020-04-06","2020-07-03","2021-02-01","2021-02-01","2020-06-17","2021-11-16","2021-11-19","2021-01-22","2021-01-22","2021-11-12","2022-06-02","2022-06-02","2020-01-13","2022-10-28","2020-01-13","2022-08-14","2020-04-06","2020-10-08","2020-12-04","2020-12-04","2020-12-04","2020-12-04","2022-03-31","2022-03-31","2022-03-31","2022-03-31","2021-11-19","2021-11-19","2021-11-19","2020-04-10","2020-07-31","2020-07-31","2021-01-20","2021-01-20","2021-04-12","2021-04-12","2022-04-18","2019-07-01","2019-02-08","2019-04-22","2019-04-22","2022-04-28","2019-09-07","2019-10-19","2019-10-19","2019-11-25","2019-11-25","2019-11-25","2019-02-10","2019-06-12","2019-09-10","2019-09-10","2019-09-20","2019-08-15","2019-09-25","2019-09-11","2019-09-11","2019-09-11","2022-01-06","2019-10-30","2019-03-06","2022-06-22","2019-06-14","2019-06-14","2019-09-25","2019-11-13","2019-12-18","2022-04-06","2022-04-18","2022-05-09","2022-04-28","2022-06-02","2022-06-22","2022-09-12","2022-09-12","2022-02-16","2022-05-17","2022-05-17","2022-05-17","2022-04-06","2022-10-28"],"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":[["","68462064693","ASHLYNA","TAB ","91","Select","Select",""],["","00781808926","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","67877057305","BENZONATATE","CAP 100MG","15","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","8","Select","Select",""],["","31722099601","HYDROCO\/APAP","TAB 5-325MG","8","Select","Select",""],["","65862086495","SIMPESSE","TAB ","91","Select","Select",""],["","00093313482","CAMRESE","TAB ","91","Select","Select",""],["","68382005101","MELOXICAM","TAB 15MG","30","Select","Select",""],["","72888001405","CYCLOBENZAPR","TAB 10MG","10","Select","Select",""],["","64380073706","VITAMIN","CAP 50000UNT","4","Select","Select",""],["","67877021560","CEFUROXIME","TAB 250MG","20","Select","Select",""],["","50383077504","LIDOCAINE","SOL 2% VISC","100","Select","Select",""],["","","DICYCLOMINE","CAP 10MG","","Select","Select",""],["","65862085901","FAMOTIDINE","TAB 20MG","28","Select","Select",""],["","00591544310","PREDNISONE","TAB 20MG","21","Select","Select",""],["","","TRIAMCINOLON","CRE 0.00025","","Select","Select",""],["","68382013914","TOPIRAMATE","TAB 50MG","30","Select","Select",""],["","16729017117","AMITRIPTYLIN","TAB 10MG","90","Select","Select",""],["","00093819205","CIMETIDINE","TAB 300MG","90","Select","Select",""],["","29300022701","METRONIDAZOL","TAB 500MG","14","Select","Select",""],["","68462010340","FLUCONAZOLE","TAB 150MG","2","Select","Select",""],["","80777027399","MODERNA","INJ COVID-19","0","Select","Select",""],["","65862001230","SERTRALINE","TAB 50MG","30","Select","Select",""],["","50228018005","GABAPENTIN","CAP 300MG","60","Select","Select",""],["","55111064501","OMEPRAZOLE","CAP 40MG","30","Select","Select",""],["","","DOXEPIN","CRE 0.05","","Select","Select",""],["","29033000301","SUCRALFATE","TAB 1GM","30","Select","Select",""],["","51672413204","LAMOTRIGINE","TAB 150MG","30","Select","Select",""],["","","BACITRACIN","OIN OP","","Select","Select",""],["","69238131209","PREGABALIN","CAP 75MG","90","Select","Select",""],["","","TERCONAZOLE","CRE 0.004","","Select","Select",""],["","","NEO\/POLY\/HC","SUS 1% OTIC","","Select","Select",""],["","","OPTICHAMBER","MIS DIAMOND","","Select","Select",""],["","","ONDANSETRON","TAB 4MG ODT","","Select","Select",""],["","","DOXYCYCL","CAP 100MG","","Select","Select",""],["","","LORATADINE","TAB 10MG","","Select","Select",""],["","00378729953","DROSPIR\/ETHI","TAB 3-0.02MG","28","Select","Select",""],["","53746027201","SMZ\/TMP","TAB 800-160","14","Select","Select",""],["","00168009930","KETOCONAZOLE","CRE 0.02","30","Select","Select",""],["","59746000103","METHYLPRED","TAB 4MG","21","Select","Select",""],["","00172392670","DIAZEPAM","TAB 5MG","2","Select","Select",""],["","00071101468","LYRICA","CAP 75MG","30","Select","Select",""],["","51672131200","MUPIROCIN","OIN 0.02","22","Select","Select",""],["","00093542362","GIANVI","TAB 3-0.02MG","28","Select","Select",""],["","65862052790","VENLAFAXINE","CAP 37.5 ER","90","Select","Select",""],["","27241009903","DULOXETINE","CAP 60MG","30","Select","Select",""],["","00085113204","PROVENTIL","AER HFA","7","Select","Select",""],["","16729014501","QUETIAPINE","TAB 25MG","30","Select","Select",""],["","68462072029","DROSPIRENONE","TAB ETHY EST","28","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":""}]}]}