{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DANA   M SHERWOOD","gend":1,"add":"2412 MOHAWK TRL","city":"VIRGINIA BEACH","state":"VA","zip":"23454-9998","dob":"1967-04-09","age":"","mstatus":"","insh":"20034851*01","cliId":"","pno":"757\/279-4555","cno":"757\/375-1025","email":"","ename":"","eno":"","pphy":"ELHASSAN, AMIRA S MD","ppno":"757\/738-1300","pcpadd":"4421 VIRGINIA BEACH BLVD STE 114","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23462,"pcpcounty":"","pcpid":"","pcpname":"BON SECOURS MEDICAL ASSOCIATES","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/687-3202","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R07.89","Z47.89","M17.12","M19.032","R20.2","M54.2","F43.22","M25.632","M25.642","E66.01","Z68.42","I10.","R73.03","K21.9","N39.3","M12.9","G56.02","Z87.442","Z87.891","Z90.49","Z98.1","M17.0","M18.12","G47.00","N39.46","Z68.41","F11.20","Z01.810","Z01.812","Z20.828","M47.816","I49.1","R07.9","R06.02","M54.5","K59.00","G89.29","Z12.4","M25.561","M17.11","M79.642","M47.812","R19.7","Z68.28","R11.2","Z98.84","Z00.00","NO DATA","Z11.59","M19.90","R76.8","R79.82","F43.21","F43.10","G89.4","E11.9","R13.10","Z12.11","R82.998","E78.2","R35.0","Z12.39","Z13.1","R79.89","G89.18","M19.042","M54.12","M48.02","Z71.89","Z71.3","M53.2X2","N20.1","N30.00","N13.30","M96.1","M79.672","Z96.652","M47.892","J45.909","M54.9","N95.1","M96.0"],"date":["2020-07-13","2021-01-26","2021-12-13","2021-12-13","2021-12-13","2021-12-13","2021-01-22","2021-01-26","2021-01-26","2021-04-07","2021-04-07","2021-08-29","2021-04-07","2021-04-07","2021-04-07","2021-04-07","2021-04-07","2021-04-07","2021-08-29","2021-04-07","2021-04-07","2021-12-13","2021-10-01","2020-12-29","2020-12-29","2021-04-07","2020-09-08","2020-11-07","2020-12-03","2020-11-07","2021-08-29","2020-07-14","2020-07-14","2020-07-14","2021-09-09","2020-12-29","2020-12-29","2020-12-29","2020-04-23","2020-06-04","2020-09-10","2021-10-01","2021-09-09","2021-10-01","2021-09-09","2021-10-01","2021-10-01","2021-10-01","2021-10-01","2021-10-01","2021-10-01","2021-10-01","2020-12-09","2020-12-09","2020-03-09","2021-04-07","2020-09-28","2020-09-28","2021-01-20","2020-08-12","2020-08-12","2020-08-12","2020-08-12","2020-08-12","2020-11-11","2020-11-11","2019-08-15","2019-02-12","2019-02-12","2019-02-12","2019-05-03","2019-09-16","2019-08-17","2019-08-19","2019-09-09","2019-04-05","2019-04-05","2019-05-03","2019-05-03","2019-05-03","2019-07-05","2019-05-03"],"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":[["","00406051201","OXYCOD\/APAP","TAB 5-325MG","90","Select","Select",""],["","69097081312","GABAPENTIN","CAP 100MG","90","Select","Select",""],["","","OXYCODONE","TAB 10MG","","Select","Select",""],["","62175061743","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","57237007530","ONDANSETRON","TAB 4MG","12","Select","Select",""],["","51525011301","HYOSCYAMINE","SUB 0.125MG","10","Select","Select",""],["","29300012401","MELOXICAM","TAB 7.5MG","30","Select","Select",""],["","63323056497","ENOXAPARIN","INJ 40\/0.4ML","3","Select","Select",""],["","68180072103","AMLODIPINE","TAB 10MG","30","Select","Select",""],["","50111044101","TRAZODONE","TAB 150MG","30","Select","Select",""],["","70010075401","METHOCARBAM","TAB 500MG","30","Select","Select",""],["","69097084615","CYCLOBENZAPR","TAB 10MG","90","Select","Select",""],["","00832003810","OXYBUTYNIN","TAB 5MG","90","Select","Select",""],["","49281071910","FLUBLOK","INJ 2019-20","0","Select","Select",""],["","68462030529","NORETHINDRON","TAB 0.35MG","28","Select","Select",""],["","","METOCLOPRAM","TAB 10MG","","Select","Select",""],["","","BISACODYL","TAB 5MG EC","","Select","Select",""],["","69547035302","NARCAN","SPR ","2","Select","Select",""],["","","LIDOCAINE","PAD 0.05","","Select","Select",""],["","","GAVILYTE-G","SOL ","","Select","Select",""],["","","MAPAP","CAP 500MG","","Select","Select",""],["","64380080307","RANITIDINE","TAB 150MG","60","Select","Select",""],["","00536106229","STOOL","CAP 100MG","60","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","15","Select","Select",""],["","43598050930","ESOMEPRA","CAP 20MG DR","30","Select","Select",""],["","00591367101","NABUMETONE","TAB 750MG","60","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":""}]}]}