{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"EBONY   M NORMAN","gend":1,"add":"113 POCAHONTAS DR","city":"NEWPORT NEWS","state":"VA","zip":"23602-9998","dob":"1987-07-18","age":"","mstatus":"","insh":"2087474*01","cliId":"","pno":"757\/660-5361","cno":"757\/660-5361","email":"","ename":"","eno":"","pphy":"PUTLAND, KENNETH W MD","ppno":"757\/594-4431","pcpadd":"12420 WARWICK BOULEVARD BLDG 4 SUIT","pcpcity":"NEWPORT NEWS","pcpstate":"VA","pcpzip":23606,"pcpcounty":"","pcpid":"","pcpname":"Riverside Primary Care - Hidenwood","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/594-2936","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J30.1","H10.10","R06.02","I10.","E66.01","Z68.42","E88.81","A53.0","H40.013","H04.123","M54.16","L80.","M35.01","M25.561","M25.562","M17.0","R07.89","G89.29","NO DATA","M26.609","J31.0","G47.33","M54.41","M54.40","R26.2","J98.4","M79.671","M79.672","R32.","N30.90","R35.0","R39.15","R35.1","R10.2","L02.411","Z87.2","Z79.84","Z79.899","N92.6","Z01.419","N39.3","Z11.3","B35.4","R63.5","B35.1","N39.46","N32.81","N39.0","H40.019","H10.45","F43.20","M22.2X1","M22.2X2","H69.82","R42.","E28.2","Z13.220","F41.9","E55.9","M26.622","M77.52","M77.42","M79.675","L98.9","Z23.","L73.2","E66.9","B37.2","L20.89","R51.9","S16.1XXA","M54.6","S09.90XA","S29.9XXA","S39.92XA","Z88.2","Z88.0","R06.83","R40.0","F45.8","Z00.00","F33.9","F51.05","F99.","R87.610","Z87.410","R87.810","J98.01","L81.9","R53.83","Z83.3","I44.0","M26.623","R26.89","B00.1","M47.816","M51.36","M25.551","M25.661","Z68.41","M54.9","V89.2XXA"],"date":["2020-04-06","2020-04-06","2020-04-06","2022-06-24","2021-04-27","2022-06-24","2020-06-21","2020-08-13","2020-12-02","2020-09-04","2022-03-08","2020-12-11","2020-12-02","2022-03-25","2022-03-25","2022-07-01","2021-05-04","2022-11-08","2022-11-08","2021-11-02","2021-11-02","2022-10-11","2022-03-08","2022-03-08","2022-02-17","2022-10-11","2022-11-12","2020-12-17","2021-06-16","2021-06-16","2021-06-16","2021-06-16","2021-06-16","2021-06-16","2022-04-10","2022-04-10","2022-04-10","2022-04-10","2020-07-15","2020-07-15","2020-10-26","2020-07-15","2020-07-15","2020-07-15","2020-12-11","2022-01-06","2022-07-15","2022-07-15","2022-04-13","2022-04-13","2022-08-15","2021-04-02","2021-04-02","2021-05-03","2022-06-24","2021-10-15","2022-06-24","2022-06-24","2022-06-24","2022-06-24","2020-06-04","2020-06-04","2020-06-04","2020-09-09","2021-04-27","2022-08-12","2022-06-24","2020-09-15","2020-09-15","2021-10-15","2021-10-15","2021-10-15","2021-10-15","2021-10-15","2021-10-15","2021-10-15","2021-10-15","2021-12-20","2021-12-20","2022-06-24","2022-04-06","2021-12-22","2021-12-22","2021-12-22","2022-02-17","2022-02-17","2022-02-17","2020-03-11","2020-05-11","2021-04-05","2021-04-05","2021-04-27","2021-05-06","2021-06-21","2021-06-28","2022-11-08","2022-11-08","2022-11-08","2020-03-06","2020-03-06","2021-10-18","2021-10-18"],"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":[["","13668000905","CITALOPRAM","TAB 10MG","30","Select","Select",""],["","16729018201","HYDROCHLOROT","TAB 12.5MG","90","Select","Select",""],["","00173071820","FLOVENT","AER 44MCG","11","Select","Select",""],["","51672404801","CLOTRIM\/BETA","CRE DIPROP","30","Select","Select",""],["","00555905058","KARIVA","TAB 28 DAY","84","Select","Select",""],["","42571012290","LEVOCETIRIZI","TAB 5MG","90","Select","Select",""],["","68462038630","SOLIFENACIN","TAB 5MG","90","Select","Select",""],["","67877032105","IBUPROFEN","TAB 800MG","270","Select","Select",""],["","00005200010","PREVNAR","INJ ","0","Select","Select",""],["","00006483703","PNEUMOVAX","INJ 25\/0.5","0","Select","Select",""],["","00781707787","METRONIDAZOL","GEL 0.75%VAG","70","Select","Select",""],["","59310057922","PROAIR","AER ","26","Select","Select",""],["","52565001829","CLINDAMYCIN","SOL 0.01","30","Select","Select",""],["","00378699252","ALBUTEROL","NEB 1.25MG\/3","225","Select","Select",""],["","65862057490","MONTELUKAST","TAB 10MG","90","Select","Select",""],["","00074012402","HUMIRA","INJ 80\/0.8ML","2","Select","Select",""],["","68382075810","METFORMIN","TAB 500MG","90","Select","Select",""],["","47335093890","AZELASTINE","DRO 0.0005","6","Select","Select",""],["","45802091987","CETIRIZINE","TAB 10MG","90","Select","Select",""],["","47781057701","METHENAM","TAB 1GM","60","Select","Select",""],["","65162019050","NAPROXEN","TAB 500MG","20","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","48","Select","Select",""],["","16571066001","MECLIZINE","TAB 12.5MG","30","Select","Select",""],["","70710113803","FLUCONAZOLE","TAB 100MG","8","Select","Select",""],["","00093321915","KETOCONAZOLE","CRE 0.02","15","Select","Select",""],["","51991081901","PROPRANOLOL","CAP 120MG ER","180","Select","Select",""],["","65162083366","DICLOFENAC","GEL 0.01","300","Select","Select",""],["","00591352530","LIDOCAINE","PAD 0.05","30","Select","Select",""],["","00472016615","NYSTATIN","OIN 100000","15","Select","Select",""],["","62175061743","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","33342004910","IRBESARTAN","TAB 300MG","90","Select","Select",""],["","70700012285","VOLNEA","TAB ","84","Select","Select",""],["","59267030401","PFIZER","INJ BA4\/BA5","0","Select","Select",""],["","59746000103","METHYLPRED","TAB 4MG","21","Select","Select",""],["","00093026415","FLUOCINONIDE","OIN 0.0005","60","Select","Select",""],["","53489011905","DOXYCYCL","CAP 100MG","60","Select","Select",""],["","00234057508","HIBICLENS","LIQ 0.04","236","Select","Select",""],["","23155013525","DOXYCYC","TAB 100MG","60","Select","Select",""],["","69097015907","MELOXICAM","TAB 15MG","30","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","20","Select","Select",""],["","55111029336","SUMATRIPTAN","TAB 100MG","9","Select","Select",""],["","41100080743","CORICIDIN","CAP CONG\/CGH","20","Select","Select",""],["","47781030301","NITROFURANTN","CAP 100MG","14","Select","Select",""],["","59779045839","CVS","TAB 10MG","90","Select","Select",""],["","31722070530","VALACYCLOVIR","TAB 1GM","16","Select","Select",""],["","00143992801","CIPROFLOXACN","TAB 500MG","10","Select","Select",""],["","43386048024","ORPHENADRINE","TAB 100MG ER","20","Select","Select",""],["","69584061150","METHOCARBAM","TAB 500MG","40","Select","Select",""],["","00378235193","ESOMEPRA","CAP 40MG DR","30","Select","Select",""],["","27808006502","PROMETH\/COD","SOL 6.25-10","120","Select","Select",""],["","66993060536","ETONOGESTERE","MIS ETHY EST","3","Select","Select",""],["","08373982700","OPTICHAMBER","MIS DIA LG","1","Select","Select",""],["","00555077902","MEDROXYPR","TAB 10MG","10","Select","Select",""],["","39328010610","PRENATAL","TAB 27-1MG","90","Select","Select",""],["","66993060536","ETONOGESTREL","MIS ETHY EST","3","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","30","Select","Select",""],["","16729042201","TACROLIMUS","OIN 0.001","100","Select","Select",""],["","00173068220","VENTOLIN","AER ","54","Select","Select",""],["","49281042050","FLUZONE","INJ 2020-21","0","Select","Select",""],["","70461042010","FLUCLVX","INJ 2020-21","0","Select","Select",""],["","58160084252","BOOSTRIX","INJ ","0","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":""}]}]}