{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"PAUL   R LADD","gend":0,"add":"28035 COLOSSE ROAD","city":"CARRSVILLE","state":"VA","zip":"23315-9998","dob":"1975-05-24","age":"","mstatus":"","insh":"20049151*01","cliId":"","pno":"540\/588-8669","cno":"540\/855-8669","email":"","ename":"","eno":"","pphy":"KOLLI, SANTHA MD","ppno":"757\/738-1375","pcpadd":"148 BURNETTS WAY STE 107","pcpcity":"SUFFOLK","pcpstate":"VA","pcpzip":23434,"pcpcounty":"","pcpid":"","pcpname":"BON SECOURS MEDICAL GROUP HAMPTON ROADS PRIMARY CARE LLC","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/934-6935","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G91.9","L91.9","R23.8","F34.1","F41.1","G47.33","F43.21","G43.009","G45.4","G80.9","Z98.2","R41.3","H54.3","Z76.89","E66.9","J30.9","K21.9","M54.5","E78.5","G43.909","Z68.33","Z79.899","Z88.5","Z88.0","Z88.8","Z82.49","R40.4","H47.20","H55.01","F33.1","E78.2","R73.03","Z23.","R74.8","Z12.11","Z13.6","Z13.29","Z13.228","Z13.0","NO DATA","H52.13","H52.203","S06.0X1A","J20.9","J01.90","M54.9","M79.604","J30.89","Z13.220","R94.5","G44.319","S60.221A","W01.198A","Y92.481","R27.0","H54.7","G93.89","Z68.36","R29.898","R51.","R53.1","R29.2","R26.2","Z86.69","G43.019","E66.01","Z68.35","J34.89","L03.211","L53.9","Z71.9","J30.81","Z80.1","Z68.37","R53.83","H40.013","H47.22","H55.00","U07.1","H25.13","H40.012","R79.89","K76.0","E66.09","Z68.34","R05.9","R09.81","R09.82","R06.00","Z12.2","Z57.9","Z77.090","Z11.1"],"date":["2021-06-17","2020-09-30","2020-09-30","2020-12-15","2021-03-22","2021-06-01","2021-03-22","2021-11-17","2021-06-17","2022-02-01","2022-02-01","2021-06-19","2021-06-17","2021-06-17","2022-09-22","2022-03-07","2022-09-22","2020-09-02","2022-09-22","2021-06-17","2021-06-17","2022-06-10","2022-02-01","2022-02-01","2022-02-01","2021-06-17","2021-06-17","2021-11-29","2021-07-13","2020-11-19","2022-03-07","2021-11-17","2022-11-02","2021-11-17","2021-11-17","2021-11-17","2022-06-10","2022-06-10","2022-06-10","2021-11-29","2021-11-29","2021-11-29","2020-05-19","2020-02-08","2020-02-08","2020-04-07","2020-04-07","2020-04-01","2020-04-01","2020-04-01","2020-04-07","2020-04-07","2020-04-07","2020-04-07","2020-04-07","2022-02-01","2019-01-09","2019-07-29","2019-03-20","2019-06-26","2019-03-21","2019-03-19","2019-03-19","2019-03-19","2019-07-29","2019-07-29","2022-03-07","2019-05-14","2019-10-29","2019-06-10","2019-06-10","2022-09-22","2022-09-22","2022-09-22","2022-06-10","2022-08-29","2022-07-14","2022-07-14","2022-02-01","2022-08-29","2022-08-29","2022-01-19","2022-01-19","2022-01-19","2022-01-19","2022-02-01","2022-02-01","2022-02-01","2022-11-02","2022-11-02","2022-11-02","2022-11-02","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":[["","16571040210","CETIRIZINE","TAB 10MG","30","Select","Select",""],["","70377002811","ATORVASTATIN","TAB 20MG","90","Select","Select",""],["","24208046325","LATANOPROST","SOL 0.00005","2","Select","Select",""],["","23155005519","NARATRIPTAN","TAB 2.5MG","9","Select","Select",""],["","00002143611","EMGALITY","INJ 120MG\/ML","1","Select","Select",""],["","65162067684","AZELASTINE","SPR 0.001","30","Select","Select",""],["","31722071390","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","60505082901","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","55111029309","SUMATRIPTAN","TAB 100MG","30","Select","Select",""],["","","LISINOPRIL","TAB 2.5MG","","Select","Select",""],["","67877026218","RIZATRIPTAN","TAB 10MG","10","Select","Select",""],["","69206012090","ELFOLATE","TAB 15MG","90","Select","Select",""],["","59779045888","ALLERGY","TAB 10MG","90","Select","Select",""],["","49281041950","FLUZONE","INJ 2019-20","0","Select","Select",""],["","80777027399","MODERNA","INJ COVID-19","0","Select","Select",""],["","59779033001","CVS","DRO 0.025%OP","10","Select","Select",""],["","","BENZONATATE","CAP 100MG","","Select","Select",""],["","00591264001","BUT\/APAP\/CAF","CAP ","30","Select","Select",""],["","","ALBUTEROL","AER HFA","","Select","Select",""],["","","DOXYCYCL","TAB 100MG","","Select","Select",""],["","45963055650","GABAPENTIN","CAP 300MG","30","Select","Select",""],["","","L-METHYLFOLA","CAP FORTE 15","","Select","Select",""],["","","METHOCARBAM","TAB 500MG","","Select","Select",""],["","","LIDOCAINE","PAD 0.05","","Select","Select",""],["","","PROAIR","AER ","","Select","Select",""],["","","VENTOLIN","AER ","","Select","Select",""],["","67877032105","IBUPROFEN","TAB 800MG","30","Select","Select",""],["","69097012203","TOPIRAMATE","TAB 25MG","60","Select","Select",""],["","50428039690","LUBRICNT","DRO 0.4-0.3%","10","Select","Select",""],["","55513084101","AIMOVIG","INJ 70MG\/ML","1","Select","Select",""],["","63304069301","CLINDAMYCIN","CAP 300MG","15","Select","Select",""],["","43386035701","HYDROCO\/APAP","TAB 7.5-325","12","Select","Select",""],["","00591565810","CYCLOBENZAPR","TAB 10MG","30","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","40","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":""}]}]}