{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"NICOLETTE KAY","gend":1,"add":"900 COUNTY ST APT 416","city":"PORTSMOUTH","state":"VA","zip":"23704-9998","dob":"1971-03-11","age":"","mstatus":"","insh":"20045204*01","cliId":"","pno":"757\/405-6175","cno":"","email":"","ename":"","eno":"","pphy":"COCHRAN, DONALD L MD","ppno":"757\/397-1246","pcpadd":"640 NORTH ST","pcpcity":"PORTSMOUTH","pcpstate":"VA","pcpzip":23704,"pcpcounty":"","pcpid":"","pcpname":"FIRST CARE PC","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/397-0089","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I10.","Z12.39","F31.10","F31.11","F31.9","T14.90XA","R53.1","Z00.00","F41.1","S82.90XA","R07.82","R07.9","Z74.01","S14.3XXA","S22.41XA","S22.49XA","W19.XXXA","G54.0","F32.9","S20.211A","S06.9X0A","E11.9","M19.90","F17.200","R51.9","F41.9","Y04.8XXA","N13.0","M48.56XA","F10.20","F14.10","F12.10","Z20.822","Z59.02","Z62.810","Z88.0","Z88.1","F33.1","F31.0","J02.9","R09.81","Z79.899","F17.210","U07.1","Z79.1","R06.02","M25.561"],"date":["2022-01-05","2020-02-21","2021-04-25","2021-03-15","2021-12-24","2021-12-28","2021-12-26","2020-06-22","2020-02-07","2021-12-24","2021-12-24","2022-01-05","2021-12-24","2021-12-28","2021-12-28","2022-01-19","2021-12-28","2021-12-26","2021-03-22","2021-12-24","2021-12-24","2022-01-05","2022-01-05","2021-12-24","2021-12-24","2021-02-08","2021-12-24","2021-12-24","2021-12-24","2021-12-24","2021-12-24","2021-12-24","2022-01-02","2021-12-24","2021-12-24","2021-12-24","2021-12-24","2019-02-24","2019-08-01","2022-01-02","2022-01-02","2022-01-05","2022-01-05","2022-01-05","2022-01-05","2022-01-05","2022-10-04"],"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":[["","42806064810","DIPHENHYDRAM","CAP 25MG","20","Select","Select",""],["","16729014501","QUETIAPINE","TAB 25MG","30","Select","Select",""],["","69547035302","NARCAN","SPR ","2","Select","Select",""],["","57896020110","PAIN","TAB 500MG","30","Select","Select",""],["","67877022310","GABAPENTIN","CAP 300MG","90","Select","Select",""],["","10702001850","OXYCODONE","TAB 5MG","25","Select","Select",""],["","41167005840","ASPERCREME","PAD LIDO 4%","6","Select","Select",""],["","27241000150","RISPERIDONE","TAB 1MG","30","Select","Select",""],["","70677003201","SM","DIS 21MG\/24H","7","Select","Select",""],["","","AMLODIPINE","TAB 5MG","","Select","Select",""],["","68462019005","NAPROXEN","TAB 500MG","30","Select","Select",""],["","57896030410","STOOL","TAB 8.6-50MG","30","Select","Select",""],["","70010075405","METHOCARBAM","TAB 500MG","45","Select","Select",""],["","33342005510","PIOGLITAZONE","TAB 30MG","30","Select","Select",""],["","69543038810","KETOROLAC","TAB 10MG","20","Select","Select",""],["","50580049660","TYLENOL","TAB 325MG","20","Select","Select",""],["","10702000709","CYCLOBENZAPR","TAB 10MG","20","Select","Select",""],["","50458014030","INVOKANA","TAB 100MG","30","Select","Select",""],["","60505258008","ATORVASTATIN","TAB 40MG","30","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":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"comment":[["","","",""],[""],[""],[""],[""],[""]],"sub":[]}}},{"a":{"indx":["1",""],"comment":["",""],"sub":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"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":""}]}]}