{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JACQUELINE   P POPE","gend":1,"add":"129 FOREST PINE RD APT A","city":"FRANKLIN","state":"VA","zip":"23851-9998","dob":"1964-05-01","age":"","mstatus":"","insh":"20058044*01","cliId":"","pno":"919\/348-7173","cno":"919\/348-7173","email":"","ename":"","eno":"","pphy":"ESCANIO, BELINDA O MD","ppno":"757\/562-4111","pcpadd":"1378 ARMORY DR","pcpcity":"FRANKLIN","pcpstate":"VA","pcpzip":23851,"pcpcounty":"","pcpid":"","pcpname":"BON SECOURS MEDICAL GROUP HAMPTON ROADS PRIMARY CARE LLC","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/562-3469","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J45.909","M50.30","K76.89","R97.0","Z85.038","C78.7","R11.0","R63.4","C19.","K43.2","R93.7","Z01.810","Z01.818","Z01.812","Z20.828","C18.9","R94.31","H61.23","H66.001","E11.9","D64.9","I10.","E78.5","Z79.84","Z79.899","Z83.3","H92.01","K43.9","Z98.890","Z90.49","E11.3291","R16.0","C53.9","J98.6","Z11.59","K76.9","G89.18","Z76.89","E44.0","R63.0","E11.69","Z86.39","Z83.49","Z87.19","Z68.20","M65.342","R11.2","K21.9","E11.65","F12.90","D50.9","F41.9","NO DATA","K82.4","I95.89","Z92.21","Z80.2","Z82.49","Z87.891","Z98.51","D64.89","S90.862A","M19.90","S90.466A","J40.","R06.2","Z20.822","E11.49","Z12.4","R05.","R11.10","R19.7","J02.9","J20.9","N95.1","F41.8","N95.0","C18.8","E87.5","Z45.2","C43.72","M47.812","M54.12","G62.9","Z68.23","E61.1","J45.901","G89.4","M54.5","R44.0","K64.8","K22.4","K21.0","K29.50","Z95.828","Z76.0","R92.8","Z68.22","M79.81","M79.603","Z12.11","Z09.","K29.60","F11.20","R07.9","C79.51","C18.6","C77.1","G89.3","I36.1","M25.512","M75.92","M89.9","M25.519","M54.2","H16.223","N30.01","E87.6","C78.00","R63.8","Z68.21","E78.2","R07.81","R91.8","C79.9","M51.04","R10.13","G47.00","K59.00","R53.81","Z51.5","M50.20","Z79.891","R07.82","R59.0","C34.90","R04.2","J18.8","I48.91","Z80.0","Z82.5","M48.02","S46.812S","C77.9","C79.70","C79.89","I47.1","E11.40","K59.03","T40.2X5A","C78.5","R60.9","M79.89"],"date":["2022-11-11","2020-03-06","2020-07-01","2020-03-23","2022-11-14","2022-08-24","2022-01-03","2021-01-06","2022-04-13","2021-09-21","2020-05-26","2020-07-31","2020-07-31","2022-01-07","2020-07-31","2022-11-15","2021-09-18","2021-09-15","2021-09-15","2022-08-30","2021-09-15","2022-11-11","2021-10-01","2022-07-05","2022-08-30","2021-09-15","2021-09-15","2021-09-16","2022-02-24","2022-02-24","2021-12-08","2020-03-16","2020-03-16","2020-03-16","2020-06-15","2020-06-15","2020-08-08","2020-08-12","2022-07-05","2021-11-02","2022-01-03","2021-10-01","2021-10-01","2021-10-01","2022-07-05","2021-11-19","2022-10-20","2022-01-17","2022-01-17","2021-12-29","2021-12-29","2021-12-29","2022-11-16","2020-08-04","2020-08-04","2020-08-04","2020-08-04","2022-07-05","2022-11-11","2020-08-04","2020-10-21","2021-06-09","2021-11-02","2021-06-09","2021-08-03","2021-11-02","2022-01-26","2021-11-02","2021-05-28","2020-01-07","2020-01-07","2020-01-07","2020-01-07","2020-01-07","2020-02-25","2022-06-27","2020-02-25","2020-06-17","2021-03-31","2019-06-17","2019-06-17","2019-09-09","2022-08-03","2019-09-09","2019-09-09","2019-06-24","2019-08-12","2019-12-13","2019-11-13","2019-11-26","2019-08-13","2019-10-01","2019-10-01","2019-10-01","2019-06-17","2019-06-20","2019-06-20","2019-06-25","2019-08-03","2019-08-03","2019-08-13","2019-08-13","2019-10-01","2019-10-16","2022-07-08","2022-09-01","2022-10-05","2022-10-07","2022-11-11","2022-07-05","2022-08-30","2022-08-16","2022-08-16","2022-08-16","2022-08-16","2022-06-22","2022-08-24","2022-11-11","2022-11-15","2022-08-24","2022-08-12","2022-11-11","2022-07-05","2022-07-08","2022-08-03","2022-08-03","2022-11-11","2022-11-11","2022-07-08","2022-07-08","2022-07-08","2022-07-19","2022-08-30","2022-07-08","2022-05-04","2022-06-27","2022-11-15","2022-07-05","2022-07-05","2022-07-05","2022-07-05","2022-07-12","2022-06-13","2022-11-11","2022-11-11","2022-11-11","2022-11-11","2022-11-11","2022-11-11","2022-11-11","2022-10-20","2022-11-01","2022-11-01"],"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":[["","68180072003","AMLODIPINE","TAB 5MG","30","Select","Select",""],["","00597015230","JARDIANCE","TAB 10MG","90","Select","Select",""],["","00406051205","OXYCOD\/APAP","TAB 5-325MG","60","Select","Select",""],["","23155010405","METFORMIN","TAB 1000MG","60","Select","Select",""],["","00406911276","FENTANYL","DIS 12MCG\/HR","10","Select","Select",""],["","65162010150","GABAPENTIN","CAP 100MG","90","Select","Select",""],["","68462015713","ONDANSETRON","TAB 4MG ODT","10","Select","Select",""],["","42858080201","MORPHINE","TAB 30MG ER","60","Select","Select",""],["","29300012810","HYDROCHLOROT","TAB 25MG","30","Select","Select",""],["","59267102501","PFIZER","INJ ADLT RTU","0","Select","Select",""],["","","HYDROXYZ","TAB 25MG","","Select","Select",""],["","65862069730","VENLAFAXINE","CAP 150MG ER","30","Select","Select",""],["","24208079535","NEO\/POLY\/DEX","OIN 0.1% OP","4","Select","Select",""],["","65862056090","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","16729000517","SIMVASTATIN","TAB 20MG","30","Select","Select",""],["","00173068220","VENTOLIN","AER ","18","Select","Select",""],["","69238137403","TOBRA\/DEXAME","SUS 0.3-0.1%","5","Select","Select",""],["","00254100752","ALBUTEROL","AER HFA","7","Select","Select",""],["","64380080807","IBUPROFEN","TAB 600MG","20","Select","Select",""],["","00555060602","MEGESTROL","TAB 20MG","30","Select","Select",""],["","00904698640","MUCUS","TAB 600MG ER","40","Select","Select",""],["","00363000220","EASY-LAX","TAB 8.6-50MG","30","Select","Select",""],["","69097052444","DICLOFENAC","GEL 0.01","100","Select","Select",""],["","59746000103","METHYLPRED","TAB 4MG","21","Select","Select",""],["","65862050320","AMOX\/K","TAB 875-125","20","Select","Select",""],["","","CAPECITABINE","TAB 500MG","","Select","Select",""],["","00536124801","STIMULANT","TAB 8.6-50MG","30","Select","Select",""],["","00591352530","LIDOCAINE","PAD 0.05","30","Select","Select",""],["","00713052612","PROMETHEGAN","SUP 25MG","60","Select","Select",""],["","","METOCLOPRAM","TAB 5MG","","Select","Select",""],["","00093314705","CEPHALEXIN","CAP 500MG","28","Select","Select",""],["","57237001106","MIRTAZAPINE","TAB 15MG ODT","30","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","10","Select","Select",""],["","45802086866","POLYETH","POW 3350 NF","30","Select","Select",""],["","00172572860","FAMOTIDINE","TAB 20MG","10","Select","Select",""],["","57664047758","METOPROL","TAB 50MG","60","Select","Select",""],["","00185012201","NITROFURANTN","CAP 100MG","14","Select","Select",""],["","50111033402","METRONIDAZOL","TAB 500MG","14","Select","Select",""],["","00406012305","HYDROCO\/APAP","TAB 5-325MG","60","Select","Select",""],["","64380071306","BENZONATATE","CAP 200MG","21","Select","Select",""],["","17478076206","DRONABINOL","CAP 5MG","60","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","57237002801","AMOXICILLIN","TAB 500MG","15","Select","Select",""],["","74312019939","D3","CAP 2000UNIT","60","Select","Select",""],["","31604002585","VITAMIN","CAP 2000UNIT","90","Select","Select",""],["","00781808926","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","","BROM\/PSE\/DM","SYP ","","Select","Select",""],["","","IMODIUM","TAB 2MG","","Select","Select",""],["","00597014030","TRADJENTA","TAB 5MG","30","Select","Select",""],["","","LEVOFLOXACIN","TAB 500MG","","Select","Select",""],["","67877048284","TELMISARTAN","TAB 20MG","30","Select","Select",""],["","","OXYCODONE","TAB 5MG","","Select","Select",""],["","53885027210","ONETOUCH","TES VERIO","100","Select","Select",""],["","55111018015","TIZANIDINE","TAB 4MG","28","Select","Select",""],["","60432060816","PROMETHAZINE","SYP 6.25\/5ML","280","Select","Select",""],["","51672404003","ENALAPRIL","TAB 20MG","30","Select","Select",""],["","65862019401","FLUOXETINE","CAP 40MG","90","Select","Select",""],["","68462019005","NAPROXEN","TAB 500MG","30","Select","Select",""],["","00406048410","APAP\/CODEINE","TAB 300-30MG","60","Select","Select",""],["","00378415101","TRAMADOL","TAB 50MG","5","Select","Select",""],["","57599000200","FREESTYLE    MIS READER","MIS READER","1","Select","Select",""],["","68382013805","TOPIRAMATE","TAB 25MG","90","Select","Select",""],["","00054001829","PREDNISONE","TAB 20MG","15","Select","Select",""],["","57237004105","PENICILLN","TAB 500MG","30","Select","Select",""],["","69547035302","NARCAN","SPR ","2","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":""}]}]}