{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CHRISTINA   M SUTMAN","gend":1,"add":"137 RANCH DR","city":"NEWPORT NEWS","state":"VA","zip":"23608-9998","dob":"1974-03-19","age":"","mstatus":"","insh":"20053619*01","cliId":"","pno":"757\/833-8464","cno":"757\/833-8464","email":"","ename":"","eno":"","pphy":"MAYER, BRUCE MD","ppno":"757\/566-2045","pcpadd":"7151 RICHMOND ROAD SUITE 403","pcpcity":"WILLIAMSBURG","pcpstate":"VA","pcpzip":23188,"pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/741-2735","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N95.1","Z23.","G47.9","R61.","F41.1","F32.2","K21.9","M62.838","Z72.0","M25.552","M54.9","G89.29","R76.8","F11.20","R10.9","F41.9","R53.1","R10.84","R93.89","K11.23","H69.83","H92.03","R13.13","N39.0","F19.10","Z91.89","B18.2","Z13.89","F43.10","N30.00","F17.200","V62.84","F15.10","F05.","F11.23","F32.9","M89.8X1"],"date":["2020-03-04","2022-09-23","2020-02-17","2020-02-17","2020-08-19","2020-04-15","2022-06-06","2020-03-04","2020-02-17","2020-03-04","2020-04-15","2020-04-15","2020-08-19","2022-09-23","2022-01-16","2022-09-23","2020-06-24","2022-01-16","2022-01-16","2022-06-06","2022-06-06","2022-06-06","2022-06-06","2022-08-26","2020-08-19","2020-06-25","2020-09-15","2021-10-15","2021-10-15","2021-10-15","2021-10-15","2020-06-26","2020-06-26","2020-06-26","2020-06-26","2020-06-26","2020-08-19"],"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":[["","65862052405","GABAPENTIN","TAB 800MG","90","Select","Select",""],["","00046110081","PREMARIN","TAB 0.3MG","30","Select","Select",""],["","00228212750","CLONIDINE","TAB 0.1MG","60","Select","Select",""],["","00591079501","DICYCLOMINE","TAB 20MG","60","Select","Select",""],["","47781035603","BUPREN\/NALOX","MIS 4-1MG","60","Select","Select",""],["","42806034501","AMPHET\/DEXTR","TAB 30MG","60","Select","Select",""],["","10702000350","PROMETHAZINE","TAB 25MG","25","Select","Select",""],["","12496120803","SUBOXONE","MIS 8-2MG","60","Select","Select",""],["","65862086001","FAMOTIDINE","TAB 40MG","30","Select","Select",""],["","60505082901","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","13668001005","CITALOPRAM","TAB 20MG","30","Select","Select",""],["","70954002010","PRAZOSIN","CAP 2MG","30","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","00069108530","PAXLOVID","TAB 300-100","30","Select","Select",""],["","57237000630","FLUCONAZOLE","TAB 200MG","2","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","14","Select","Select",""],["","50111033401","METRONIDAZOL","TAB 500MG","14","Select","Select",""],["","00591565810","CYCLOBENZAPR","TAB 10MG","60","Select","Select",""],["","00093321205","CLONAZEPAM","TAB 1MG","60","Select","Select",""],["","14539067501","HYDROXYZ","CAP 50MG","90","Select","Select",""],["","55111015810","OMEPRAZOLE","CAP 20MG","30","Select","Select",""],["","16729028912","BUSPIRONE","TAB 30MG","60","Select","Select",""],["","80777027398","MODERNA","INJ COVID-19","0","Select","Select",""],["","68180012101","CEPHALEXIN","CAP 250MG","30","Select","Select",""],["","59779044574","CVS","DIS 14MG\/24H","14","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","8","Select","Select",""],["","00536589488","NICOTINE","DIS 7MG\/24HR","14","Select","Select",""],["","00173068220","VENTOLIN","AER ","18","Select","Select",""],["","00085113201","PROVENTIL","AER HFA","7","Select","Select",""],["","70461032003","FLUCLVX","INJ 2020-21","0","Select","Select",""],["","72626270101","SOFOS\/VELPAT","TAB 400-100","28","Select","Select",""],["","61958220101","EPCLUSA","TAB 400-100","28","Select","Select",""],["","47781030301","NITROFURANTN","CAP 100MG","14","Select","Select",""],["","57844013001","ADDERALL","TAB 30MG","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":""}]}]}