{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ERSULA SUMMERS","gend":1,"add":"6021 OLD COLLEGE DR APT B","city":"SUFFOLK","state":"VA","zip":"23435-9998","dob":"1989-12-28","age":"","mstatus":"","insh":"2157002*01","cliId":"","pno":"757\/472-7262","cno":"757\/472-7262","email":"","ename":"","eno":"","pphy":"CLARK, DONNA P NP","ppno":"757\/706-3768","pcpadd":"12388 WARWICK BLVD STE 302","pcpcity":"NEWPORT NEWS","pcpstate":"VA","pcpzip":23606,"pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/926-5465","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R69.","T14.90XA","Z04.1","Z3A.15","R10.33","M25.551","O26.612","K80.20","O98.412","B17.9","O99.89","R55.","R77.8","E86.0","N17.9","R10.2","N30.01","N17.1","R79.89","N12.","K42.9","F33.1","O26.891","R10.9","Z72.0","R51.","O86.12","B19.20","O26.63","O99.335","F17.200","Z86.19","Z79.899","Z88.0","Z82.49","Z83.3","Z84.1","D61.818","D69.6","B18.2","F12.10","F10.129","I12.9","N18.9","E87.6","K59.00","Z20.828","O16.2","Z3A.25","R82.998","O14.93","O14.92","O42.012","O32.1XX0","Z3A.27","Z37.0","R51.9","R74.01","Z23.","Z11.1","K08.89","H92.03","I10.","F17.210","U07.1","B35.1","E03.9","E55.9","K02.9","F41.1","Z13.31","F90.9","O60.12X0","K83.1","O98.42","O26.62","O26.872","O42.912","O13.4","O35.8XX0","Z30.013","Z11.59","Z34.83","O72.2","N71.9","R10.84","I42.9","Z30.2","Z30.09","F19.10","Z02.0","K03.81","Z3A.19","O14.02","O40.2XX0","K02.51","O98.511","J06.9","Z3A.08","N39.0","Z77.21","N89.8","Z39.1","Z32.01","O26.892","N94.9","O16.9","G89.18","K42.0","Z11.3","NO DATA","J02.9","R05.9","R09.81","Z20.822"],"date":["2020-03-25","2020-03-25","2020-03-27","2020-03-27","2020-03-27","2020-03-27","2020-06-15","2020-06-12","2020-06-15","2020-06-12","2020-07-19","2020-07-25","2020-07-19","2020-07-24","2020-07-25","2020-07-24","2020-07-25","2020-07-25","2020-07-25","2020-10-21","2020-08-06","2021-07-20","2020-01-12","2020-08-06","2020-08-07","2020-01-28","2020-06-30","2020-06-28","2020-06-28","2020-06-28","2020-07-19","2020-06-28","2020-06-28","2022-07-12","2020-07-19","2020-06-28","2020-06-28","2020-07-19","2020-07-19","2021-04-15","2020-07-19","2020-07-19","2020-07-19","2020-07-19","2020-07-19","2020-07-19","2021-09-20","2020-06-05","2020-06-05","2020-06-05","2020-06-15","2020-06-15","2020-06-15","2020-06-15","2020-06-15","2020-06-15","2021-05-23","2020-10-21","2021-04-28","2021-04-28","2022-07-12","2021-12-26","2022-10-08","2022-07-12","2022-01-04","2022-10-08","2022-10-08","2022-10-08","2022-10-08","2022-10-08","2022-10-08","2022-10-08","2020-06-15","2020-06-15","2020-06-15","2020-06-15","2020-06-15","2020-06-15","2020-06-15","2020-06-15","2020-06-15","2020-06-15","2020-06-15","2020-06-28","2020-06-28","2020-06-28","2020-07-21","2020-09-21","2020-08-13","2021-02-02","2021-02-02","2022-07-12","2020-04-21","2020-06-09","2020-06-09","2022-01-10","2020-01-26","2021-05-23","2020-01-26","2021-03-11","2021-03-11","2021-03-11","2020-06-18","2020-02-24","2020-03-10","2020-03-10","2020-06-05","2020-06-16","2020-09-21","2021-03-03","2022-01-04","2022-01-04","2022-01-04","2022-01-04","2022-01-18"],"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":[["","67877019805","AMLODIPINE","TAB 5MG","30","Select","Select",""],["","65162046650","IBUPROFEN","TAB 800MG","30","Select","Select",""],["","13668013601","ESCITALOPRAM","TAB 10MG","30","Select","Select",""],["","65862049001","QUETIAPINE","TAB 50MG","30","Select","Select",""],["","63304069301","CLINDAMYCIN","CAP 300MG","46","Select","Select",""],["","00527150537","AMPHET\/DEXTR","TAB 20MG","90","Select","Select",""],["","62332002791","LOSARTAN","TAB 25MG","30","Select","Select",""],["","57844012001","ADDERALL","TAB 20MG","60","Select","Select",""],["","53746010901","HYDROCO\/APAP","TAB 5-325MG","6","Select","Select",""],["","68180016006","AZITHROMYCIN","TAB 250MG","5","Select","Select",""],["","49483034010","ACETAMIN","TAB 325MG","60","Select","Select",""],["","00116200116","CHLORHEX","SOL 0.0012","473","Select","Select",""],["","64980030550","DENTA","CRE PLUS","51","Select","Select",""],["","69842054478","ARTHRTS","TAB 650MG","60","Select","Select",""],["","00378181377","LEVOTHYROXIN","TAB 125MCG","30","Select","Select",""],["","69452015120","VITAMIN","CAP 50000UNT","4","Select","Select",""],["","00781551501","GRISEOFULVIN","TAB MICR 500","60","Select","Select",""],["","38779068505","ALUMINUM","POW ANHYDROU","36","Select","Select",""],["","69097073102","TERBINAFINE","TAB 250MG","30","Select","Select",""],["","42858010250","OXYCOD\/APAP","TAB 5-325MG","20","Select","Select",""],["","00096070735","DRYSOL","SOL 0.2","36","Select","Select",""],["","00074262528","MAVYRET","TAB 100-40MG","84","Select","Select",""],["","16571066401","METRONIDAZOL","TAB 500MG","14","Select","Select",""],["","63304061650","DOXYCYC","CAP 100MG","14","Select","Select",""],["","11822505390","RA","TAB 10MG","30","Select","Select",""],["","11822060539","ALLERGY","TAB 10MG","30","Select","Select",""],["","60432026415","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","69238110005","DOXYCYCL","CAP 100MG","20","Select","Select",""],["","65162019050","NAPROXEN","TAB 500MG","20","Select","Select",""],["","10702025350","BUT\/APAP\/CAF","TAB ","10","Select","Select",""],["","00536100901","FERROUS","TAB 325MG","30","Select","Select",""],["","45802048678","DOCUSATE","CAP 100MG","60","Select","Select",""],["","42546026903","PRENATAL","TAB LOW IRON","90","Select","Select",""],["","10702001150","HYDROXYZ","TAB 25MG","40","Select","Select",""],["","42806050301","URSODIOL","CAP 300MG","90","Select","Select",""],["","65862085901","FAMOTIDINE","TAB 20MG","60","Select","Select",""],["","50428016183","CVS","CAP 2000UNIT","60","Select","Select",""],["","00536406301","CL","TAB 28-0.8MG","90","Select","Select",""],["","31604041107","MOOD","TAB 400MG","36","Select","Select",""],["","00904585652","CALCIUM","TAB 600MG","60","Select","Select",""],["","00904645780","DOK","CAP 100MG","60","Select","Select",""],["","00904759080","FEROSUL","TAB 325MG","30","Select","Select",""],["","69543025850","PREPLUS","TAB 27-1MG","30","Select","Select",""],["","00536589488","NICOTINE","DIS 7MG\/24HR","14","Select","Select",""],["","10702000201","PROMETHAZINE","TAB 12.5MG","30","Select","Select",""],["","10702001801","OXYCODONE","TAB 5MG","12","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","20","Select","Select",""],["","65862039010","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":""}]}]}