{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"NATASHA WILSON","gend":1,"add":"1205 MULLHOLAND CT","city":"VIRGINIA BEACH","state":"VA","zip":"23454-9998","dob":"1978-01-02","age":"","mstatus":"","insh":"20039845*01","cliId":"","pno":"757\/738-0435","cno":"757\/738-0435","email":"","ename":"","eno":"","pphy":"PATEL, SONAL MD","ppno":"757\/738-1350","pcpadd":"908 EDEN WAY N STE 101","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":23320,"pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/413-5450","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F43.10","F32.9","F31.30","F33.2","B20.","E55.9","F31.9","G62.9","F41.8","V62.84","F10.20","F10.94","Z65.8","F31.32","F41.9","Z63.5","B36.0","R60.0","F10.10","A54.9","N39.0","K21.9","NO DATA","Z91.14","Z21.","Z20.822","E78.5","R06.2","R45.851","Z74.3","B07.9","G43.009","F33.9","R51.9","F17.210","R22.41","M79.671","M72.2","F25.0","L70.0","L81.0","F19.10","R44.3","Z71.41","F10.24","B35.4","L30.9","R42.","Z79.899","Z81.8","Z81.1","Z81.3","Z11.59"],"date":["2021-07-06","2021-04-26","2021-08-28","2021-08-31","2021-04-26","2020-06-30","2021-05-04","2020-09-11","2020-09-11","2021-08-30","2021-03-05","2020-08-13","2020-09-21","2021-03-05","2021-03-05","2021-03-05","2021-04-26","2021-05-22","2021-08-30","2021-08-30","2021-08-30","2020-08-04","2021-06-29","2021-04-24","2021-06-12","2021-04-24","2021-04-28","2021-04-29","2021-06-14","2021-06-14","2021-05-05","2021-04-26","2021-04-26","2021-05-05","2021-05-05","2021-05-22","2021-05-22","2021-05-22","2021-07-15","2020-01-27","2020-02-24","2021-06-12","2021-06-12","2020-08-27","2020-09-21","2021-04-27","2021-04-27","2021-04-30","2020-09-21","2020-09-21","2020-09-21","2020-09-21","2020-08-09"],"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":[]},{"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":[["","70710122600","AMITRIPTYLIN","TAB 25MG","90","Select","Select",""],["","65862085901","FAMOTIDINE","TAB 20MG","60","Select","Select",""],["","65862049301","QUETIAPINE","TAB 200MG","30","Select","Select",""],["","13107003134","MIRTAZAPINE","TAB 15MG","30","Select","Select",""],["","10006070021","VITAMIN","TAB 100MG","30","Select","Select",""],["","10135018201","FOLIC","TAB 1MG","30","Select","Select",""],["","61958250101","BIKTARVY","TAB ","30","Select","Select",""],["","50228018005","GABAPENTIN","CAP 300MG","60","Select","Select",""],["","10135013910","PYRIDOXINE","TAB 50MG","30","Select","Select",""],["","20555002700","TAB-A-VITE","TAB ","30","Select","Select",""],["","00904699880","DOCUSATE","CAP 100MG","30","Select","Select",""],["","00555007102","ISONIAZID","TAB 300MG","15","Select","Select",""],["","61958210101","ODEFSEY","TAB ","30","Select","Select",""],["","65862069790","VENLAFAXINE","CAP 150MG ER","30","Select","Select",""],["","65862059501","DIVALPROEX","TAB 500MG ER","60","Select","Select",""],["","60505265401","TRAZODONE","TAB 100MG","30","Select","Select",""],["","65162046650","IBUPROFEN","TAB 800MG","90","Select","Select",""],["","11822030300","ACETAMIN","TAB 500MG","60","Select","Select",""],["","00904759080","FEROSUL","TAB 325MG","30","Select","Select",""],["","59676027801","EDURANT","TAB 25MG","30","Select","Select",""],["","51991074790","DULOXETINE","CAP 30MG","90","Select","Select",""],["","61958230101","VEMLIDY","TAB 25MG","30","Select","Select",""],["","61958060101","EMTRIVA","CAP 200MG","30","Select","Select",""],["","07610015540","MELATONIN","TAB 5MG","60","Select","Select",""],["","69097064202","EMTRICITABIN","CAP 200MG","30","Select","Select",""],["","68682045570","METRONIDAZOL","GEL 0.75%VAG","70","Select","Select",""],["","21922000201","CLINDAMYCIN","SOL 0.01","60","Select","Select",""],["","00536100901","FERROUS","TAB 325MG","30","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","14","Select","Select",""],["","50742026750","NORETHIN","TAB 5MG","30","Select","Select",""],["","00093321992","KETOCONAZOLE","CRE 0.02","60","Select","Select",""],["","55111015810","OMEPRAZOLE","CAP 20MG","30","Select","Select",""],["","24658031205","DOXYCYCL","TAB 100MG","30","Select","Select",""],["","16571020106","DICLOFENAC","TAB 75MG DR","60","Select","Select",""],["","65162019050","NAPROXEN","TAB 500MG","60","Select","Select",""],["","52565008704","HYDROCORTISO","LOT 0.001","118","Select","Select",""],["","72057000101","ATOPADERM","CRE ","100","Select","Select",""],["","00115146845","LIDO\/PRILOCN","CRE 2.5-2.5%","30","Select","Select",""],["","16729013616","CLONAZEPAM","TAB 0.5MG","60","Select","Select",""],["","00187516020","RETIN-A","CRE 0.00025","20","Select","Select",""],["","00472011720","TRETINOIN","CRE 0.00025","20","Select","Select",""],["","47781060730","DISULFIRAM","TAB 250MG","36","Select","Select",""],["","31722054501","LITHIUM","CAP 300MG","30","Select","Select",""],["","68462043518","ACAMPRO","TAB 333MG","180","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":""}]}]}