{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DIANE   M HENRY","gend":1,"add":"720 35TH ST","city":"NEWPORT NEWS","state":"VA","zip":"23607-9998","dob":"1977-07-23","age":"","mstatus":"","insh":"20055900*01","cliId":"","pno":"213\/992-6223","cno":"213\/992-6223","email":"","ename":"","eno":"","pphy":"AMES, MELANIE R NP","ppno":"757\/594-4111","pcpadd":"12 BRUTON AVENUE","pcpcity":"NEWPORT NEWS","pcpstate":"VA","pcpzip":23601,"pcpcounty":"","pcpid":"","pcpname":"Bruton Avenue Family Practice","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/594-4115","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I10.","F17.210","R20.2","M54.40","G89.29","R79.89","R03.0","E78.5","N95.1","R73.9","F10.239","Z91.410","Z62.810","M54.5","M19.90","K70.0","K29.70","R74.8","Z01.419","N76.0","M25.511","M20.001","F32.9","NO DATA","R51.","R11.2","K70.9","Z12.39","E66.9","Z30.09","G62.9","J30.2","Z12.11","M20.011","M25.561","M25.562","M75.01","M75.101","M17.0","Z87.891","Z79.1","Z79.899","R74.0","B35.1","L60.2","N91.1","B35.3","Z71.89","Z83.3","R74.01","F10.10","K52.9","R10.9","R19.7","M54.9","M15.9","K76.0"],"date":["2022-09-24","2021-10-27","2021-10-27","2021-10-27","2022-09-24","2021-10-27","2020-05-05","2020-06-02","2022-08-19","2020-05-05","2020-11-04","2020-11-04","2020-11-04","2020-11-04","2020-11-04","2020-11-04","2020-11-04","2020-11-04","2022-08-19","2022-08-19","2022-09-24","2022-08-19","2022-08-19","2022-08-19","2020-09-11","2020-11-07","2020-11-03","2020-02-05","2020-02-05","2020-01-22","2020-06-02","2020-06-02","2020-02-05","2022-09-22","2022-09-24","2022-09-24","2022-09-28","2022-09-28","2022-09-24","2022-09-24","2022-09-24","2022-09-24","2020-06-02","2020-06-18","2020-06-02","2020-06-02","2020-06-18","2020-06-18","2020-06-18","2020-11-10","2020-11-10","2020-11-07","2020-11-07","2020-11-07","2020-11-07","2020-11-07","2020-11-07"],"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":[["","57237001930","DULOXETINE","CAP 60MG","14","Select","Select",""],["","68180044701","QUETIAPINE","TAB 100MG","14","Select","Select",""],["","14539067501","HYDROXYZ","CAP 50MG","42","Select","Select",""],["","68645051054","HYDROCHLOROT","TAB 25MG","30","Select","Select",""],["","68382005105","MELOXICAM","TAB 15MG","14","Select","Select",""],["","29033000301","SUCRALFATE","TAB 1GM","30","Select","Select",""],["","61269073556","MICONAZOLE","CRE 0.02","28","Select","Select",""],["","55111014512","FLUCONAZOLE","TAB 150MG","2","Select","Select",""],["","42571014301","CELECOXIB","CAP 100MG","60","Select","Select",""],["","00591352530","LIDOCAINE","PAD 0.05","30","Select","Select",""],["","68382056928","ACAMPRO","TAB 333MG","42","Select","Select",""],["","29300022701","METRONIDAZOL","TAB 500MG","4","Select","Select",""],["","64380073706","VITAMIN","CAP 50000UNT","6","Select","Select",""],["","55111064501","OMEPRAZOLE","CAP 40MG","30","Select","Select",""],["","31604001281","B1","TAB 100MG","30","Select","Select",""],["","00761087840","FOLIC","TAB 400MCG","30","Select","Select",""],["","00093505998","ATORVASTATIN","TAB 20MG","30","Select","Select",""],["","00904549280","THERA-M","TAB ","14","Select","Select",""],["","16714089803","LORATADINE","TAB 10MG","30","Select","Select",""],["","68645014059","FAMOTIDINE","TAB 20MG","28","Select","Select",""],["","16571020150","DICLOFENAC","TAB 75MG DR","60","Select","Select",""],["","67877022210","GABAPENTIN","CAP 100MG","90","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","16714068203","SIMVASTATIN","TAB 10MG","30","Select","Select",""],["","00067611730","ALLERGY","TAB 10MG","30","Select","Select",""],["","51672127501","CLOTRIMAZOLE","CRE 0.01","30","Select","Select",""],["","68180087613","NORETHINDRON","TAB 0.35MG","28","Select","Select",""],["","00093220301","METOCLOPRAM","TAB 10MG","20","Select","Select",""],["","69315090401","LORAZEPAM","TAB 0.5MG","6","Select","Select",""],["","57237007710","ONDANSETRON","TAB 4MG ODT","12","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":""}]}]}