{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CAROLYN   A DUCK","gend":1,"add":"806 ROAM CT APT I","city":"NEWPORT NEWS","state":"VA","zip":"23605-9998","dob":"1961-09-26","age":"","mstatus":"","insh":"20026701*01","cliId":"","pno":"757\/975-4665","cno":"","email":"","ename":"","eno":"","pphy":"HERBERT, DWIGHT C MD","ppno":"757\/594-4431","pcpadd":"12420 WARWICK BLVD BLDG 4 SUITE 4A","pcpcity":"NEWPORT NEWS","pcpstate":"VA","pcpzip":23606,"pcpcounty":"","pcpid":"","pcpname":"Riverside Primary Care - Hidenwood","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/594-2936","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M54.2","M50.30","M96.1","M54.5","M47.816","NO DATA","G89.29","M70.61","R26.89","L29.9","I10.","H52.03","G56.13","L30.9","K21.9","T22.312A","T23.362A","T25.131A","J45.909","K58.9","M19.90","M79.7","Z90.49","Z79.899","T30.0","Z01.419","L20.82","T31.0","Z23.","Z79.891","M47.22","G56.03","Z12.11","T78.40XA","M99.03","M99.04","M99.05","M99.01","M99.02","T23.202A","X10.2XXA","T23.272A","T23.242A","T23.209A","M54.9","Z12.31","D12.5","D12.8","K57.30","K64.8","R87.612","M25.50","R20.0","Z98.890","B86.","F32.9","Z88.1","Z88.6","Z91.040","Z91.048","N61.0","Z98.1","Z80.3","Z88.8","N64.4","R10.13","T23.002A","T23.032A","R92.1","G57.01","N60.99","B07.9","Z11.59","M22.40","M16.11","M99.08","M99.00","T22.332A","M25.552","G44.201","M25.551","M62.830","R87.619","Z32.02","V58.89","N87.0","M51.36","R01.1","I35.1","I44.4","R06.09","R07.9","T23.072A","E04.1","M25.561","I45.19","R94.31","R12.","E55.9","D72.819","Z13.29","Z13.89","Z00.00","M16.0","V89.2XXS","M53.3"],"date":["2021-03-04","2021-02-09","2019-03-20","2021-02-11","2022-11-02","2021-02-09","2022-08-24","2022-09-28","2022-09-12","2021-02-13","2022-08-09","2020-05-05","2021-03-17","2021-11-15","2022-03-09","2021-11-21","2021-11-21","2021-11-21","2022-01-31","2021-11-21","2021-11-21","2022-01-31","2021-11-21","2021-11-21","2021-11-21","2021-12-16","2022-01-26","2022-01-26","2021-12-22","2019-03-20","2022-01-26","2021-03-30","2020-08-05","2020-08-05","2021-01-05","2021-01-05","2021-01-05","2021-02-09","2021-02-09","2021-11-29","2022-01-26","2021-12-07","2021-12-07","2021-12-07","2019-07-16","2021-06-23","2020-08-05","2020-08-05","2020-08-05","2020-08-05","2020-11-30","2021-02-09","2021-01-05","2021-02-09","2021-02-13","2021-02-13","2022-01-31","2021-02-13","2022-01-31","2021-07-26","2021-07-26","2021-07-26","2021-07-26","2022-01-31","2021-07-26","2022-08-24","2021-12-16","2021-12-16","2019-04-04","2020-09-25","2020-02-04","2021-06-23","2020-03-05","2020-03-05","2020-03-05","2021-01-05","2021-02-09","2021-11-21","2020-01-20","2020-01-20","2020-10-27","2020-10-27","2021-01-29","2022-01-06","2021-12-03","2022-05-24","2022-11-02","2022-05-16","2022-05-16","2022-05-25","2022-05-16","2022-05-25","2022-01-26","2022-01-26","2022-01-26","2022-05-25","2022-05-25","2022-01-31","2022-03-09","2022-03-09","2022-03-09","2022-03-09","2022-08-09","2022-09-06","2022-09-06","2022-11-02"],"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":[["","11822061283","ARTHRTS","TAB 650MG","60","Select","Select",""],["","","TRIAMCINOLON"," TRIAMCINOLON ","60","Select","Select",""],["","00527058601","DICYCLOMINE","CAP 10MG","180","Select","Select",""],["","","AMLODIPINE"," AMLODIPINE ","30","Select","Select",""],["","50228035390","PREGABALIN","CAP 100MG","30","Select","Select",""],["","51660093901","CETIRIZINE","TAB 10MG","30","Select","Select",""],["","65162083366","DICLOFENAC","GEL 0.01","100","Select","Select",""],["","11822041923","8","TAB 650MG","60","Select","Select",""],["","65162027210","SMZ\/TMP","TAB 800-160","20","Select","Select",""],["","82607066026","FLOWFLEX","KIT TEST","8","Select","Select",""],["","64380073706","VITAMIN","CAP 50000UNT","4","Select","Select",""],["","","PANTOPRAZOLE"," PANTOPRAZOLE ","30","Select","Select",""],["","69097014260","ALBUTEROL","AER HFA","20","Select","Select",""],["","11822846310","ACID","TAB 10MG","60","Select","Select",""],["","00378905593","LIDOCAINE","PAD 0.05","30","Select","Select",""],["","00093081101","NORTRIPTYLIN","CAP 25MG","90","Select","Select",""],["","43598021055","SSD","CRE 0.01","50","Select","Select",""],["","31722099601","HYDROCO\/APAP","TAB 5-325MG","30","Select","Select",""],["","69097081307","GABAPENTIN","CAP 100MG","90","Select","Select",""],["","45802006070","BACITRACIN","OIN 500\/GM","432","Select","Select",""],["","00316017516","TRIDERM","CRE 0.005","454","Select","Select",""],["","21922002107","PERMETHRIN","CRE 0.05","60","Select","Select",""],["","","HYDROXYZ","TAB 25MG","","Select","Select",""],["","65162019010","NAPROXEN","TAB 500MG","10","Select","Select",""],["","65162046510","IBUPROFEN","TAB 600MG","80","Select","Select",""],["","59746017506","PREDNISONE","TAB 20MG","10","Select","Select",""],["","68382005101","MELOXICAM","TAB 15MG","30","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","10702000750","CYCLOBENZAPR","TAB 10MG","15","Select","Select",""],["","","DULOXETINE","CAP 20MG","","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":""}]}]}