{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LAURA UMPHLETTE","gend":1,"add":"3401 GEORGE WASHINGTON HWY LOT 05","city":"PORTSMOUTH","state":"VA","zip":"23704-9998","dob":"1983-11-28","age":"","mstatus":"","insh":"2177779*01","cliId":"","pno":"757\/405-4482","cno":"","email":"","ename":"","eno":"","pphy":"LINDNER, PAUL I MD","ppno":"757\/436-0167","pcpadd":"SUITE 200 667 KINGSBOROUGH SQUARE","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":23320,"pcpcounty":"","pcpid":"","pcpname":"MAWC - TotalCare for Women","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/436-0236","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F31.62","F90.9","F12.10","R10.31","R10.2","R10.9","K76.0","R11.0","R39.15","F17.210","R53.81","R07.9","N80.0","R00.0","N80.3","Z12.4","M79.669","F31.81","V62.84","F10.20","F90.2","J45.909","I10.","N80.9","Z87.42","G89.29","N30.00","Z79.899","Z79.1","Z79.52","Z88.1","NO DATA","N93.9","Z20.822","F17.200","Z79.51","R07.89","S62.307A","V54.12","M18.9","F48.9","F99.","R03.0","R53.83","S62.347A"],"date":["2022-04-12","2022-04-12","2022-04-12","2021-11-08","2022-03-21","2021-11-08","2021-11-08","2021-11-08","2021-11-08","2022-04-21","2021-11-08","2022-01-19","2022-03-21","2022-04-22","2021-12-29","2021-12-29","2022-01-20","2022-03-11","2022-03-09","2022-03-09","2022-03-09","2022-03-09","2022-03-10","2022-03-09","2022-03-21","2021-12-20","2021-12-20","2022-01-19","2022-04-21","2022-04-21","2021-12-20","2021-11-08","2021-11-08","2022-01-19","2022-01-19","2022-01-19","2022-01-19","2022-08-10","2022-09-09","2022-09-09","2022-04-21","2022-04-21","2022-03-09","2022-03-09","2022-07-28"],"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":[["","00093816301","QUETIAPINE","TAB 200MG","90","Select","Select",""],["","65862022801","LAMOTRIGINE","TAB 100MG","90","Select","Select",""],["","42858030101","HYDROMORPHON","TAB 2MG","12","Select","Select",""],["","00527150537","AMPHET\/DEXTR","TAB 20MG","90","Select","Select",""],["","13668013601","ESCITALOPRAM","TAB 10MG","90","Select","Select",""],["","49483060350","IBUPROFEN","TAB 600MG","30","Select","Select",""],["","69097015907","MELOXICAM","TAB 15MG","30","Select","Select",""],["","00603533815","PREDNISONE","PAK 10MG","21","Select","Select",""],["","59779092306","ALLERGY","TAB 25MG","20","Select","Select",""],["","59779036751","SLEEP","TAB 25MG","20","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","14","Select","Select",""],["","75826011510","PHENAZOPYRID","TAB 200MG","3","Select","Select",""],["","47781030301","NITROFURANTN","CAP 100MG","10","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":""}]}]}