{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"RANDY POUNDERS","gend":0,"add":"102 RIVER TRACE WAY APT 3","city":"NEWPORT NEWS","state":"VA","zip":"23602-9998","dob":"1959-01-29","age":"","mstatus":"","insh":"20033545*01","cliId":"","pno":"757\/367-9483","cno":"757\/912-8122","email":"","ename":"","eno":"","pphy":"BERCASIO, ROLAND MD","ppno":"757\/594-1840","pcpadd":"STE 100 11803 JEFFERSON AVE","pcpcity":"NEWPORT NEWS","pcpstate":"VA","pcpzip":23606,"pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Family Medicine Physicians - Port Warwick","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/594-1841","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F20.0","R58.","E55.9","L82.0","M51.36","K21.9","F20.9","Z12.11","T16.9XXA","R69.","S20.211A","R07.9","V13.4XXA","R52.","R10.9","Z00.00","Z13.220","M47.816","G43.909","F41.9","F20.89","K80.20","R73.9","M54.9","R05.9","I10.","Z79.899","Z20.822","Z79.1","S01.81XA","S60.416A","N40.0","S61.216A","S09.93XA"],"date":["2021-12-14","2021-02-15","2019-07-18","2019-07-18","2021-05-05","2021-10-08","2019-07-18","2021-05-05","2021-03-08","2021-10-08","2019-05-07","2019-05-07","2019-05-07","2019-09-11","2020-12-11","2021-05-05","2021-05-05","2021-05-05","2021-05-05","2021-05-05","2021-05-05","2021-05-05","2021-05-05","2020-06-15","2021-10-08","2021-10-08","2021-10-08","2021-10-08","2021-10-08","2021-10-01","2021-10-01","2021-10-01","2021-10-01","2021-10-01"],"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":[["","","OXYBUTYNIN"," OXYBUTYNIN ","30","Select","Select",""],["","","CLONAZEPAM"," CLONAZEPAM ","30","Select","Select",""],["","","TRAMADOL"," TRAMADOL ","15","Select","Select",""],["","","OMEPRAZOLE"," OMEPRAZOLE ","60","Select","Select",""],["","","ACETAMIN"," ACETAMIN ","50","Select","Select",""],["","","RA"," RA ","30","Select","Select",""],["","","ZIPRASIDONE"," ZIPRASIDONE ","60","Select","Select",""],["","","DIVALPROEX"," DIVALPROEX ","90","Select","Select",""],["","","VITAMIN"," VITAMIN ","30","Select","Select",""],["","","ONDANSETRON"," ONDANSETRON ","20","Select","Select",""],["","","TRIAMCINOLON"," TRIAMCINOLON ","30","Select","Select",""],["","","RANITIDINE"," RANITIDINE ","20","Select","Select",""],["","","IBUPROFEN"," IBUPROFEN ","20","Select","Select",""],["","","FAMOTIDINE"," FAMOTIDINE ","20","Select","Select",""],["","","OXYTROL","DIS 3.9MG\/24","","Select","Select",""],["","","PROMETHAZINE","TAB 25MG","","Select","Select",""],["","","METHOCARBAM","TAB 750MG","","Select","Select",""],["","","PRILOSEC","TAB 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":""}]}]}