{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JESSICA   N CARLISLE","gend":1,"add":"2921 VENUS ST","city":"VIRGINIA BEACH","state":"VA","zip":"23452-9998","dob":"1987-10-20","age":"","mstatus":"","insh":"2189966*01","cliId":"","pno":"757\/642-7429","cno":"","email":"","ename":"","eno":"","pphy":"ASUNCION, CHRISTOPHER W MD","ppno":"757\/705-5265","pcpadd":"828 HEALTHY WAY","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23462,"pcpcounty":"","pcpid":"","pcpname":"Mid-Atlantic Family Medicine","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/962-2884","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N93.9","Z01.419","Z12.39","Z30.41","R06.83","R06.81","R40.0","R53.83","G47.00","G47.8","E66.01","F33.9","Z68.42","G47.33","R73.9","N92.0","Z32.02","Z78.9","Z01.818","D64.9","N84.1","M54.5","F34.1","G47.30","Z01.812","Z20.822","B37.3","R35.0","R07.0","F90.0","F41.9","E66.9","F32.9","M54.41","N64.4","F41.1","F33.1","J02.9","H10.9","H65.93","Z79.82","Z88.6","Z11.3","A59.9","N84.0","Z30.430","Z30.431","T83.32XA","Z30.432","J20.9","N92.6","R87.612","N92.5","R10.13","R11.0","R52.","R74.8","R79.89","N93.8","R74.0"],"date":["2021-05-30","2020-12-03","2020-12-03","2020-12-03","2021-02-23","2021-03-29","2021-02-23","2021-02-23","2021-03-29","2021-03-29","2021-10-14","2021-04-13","2021-10-14","2021-10-14","2021-09-23","2021-07-12","2021-06-03","2021-06-14","2021-06-30","2021-07-12","2021-07-12","2021-02-11","2021-02-11","2021-02-11","2021-07-09","2021-07-09","2021-08-31","2021-08-31","2021-08-31","2020-01-17","2020-01-17","2021-03-29","2021-03-29","2019-05-13","2019-06-13","2019-08-26","2019-08-26","2019-09-13","2019-09-13","2019-09-13","2019-05-13","2019-05-13","2019-11-27","2019-05-06","2019-08-19","2019-09-13","2019-10-14","2019-10-14","2019-10-14","2019-06-11","2019-10-21","2019-12-11","2019-07-12","2019-12-03","2019-12-03","2019-12-03","2019-12-03","2019-12-03","2019-08-19","2019-12-11"],"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":[["","00093553801","ESZOPICLONE","TAB 2MG","7","Select","Select",""],["","52817033200","CYCLOBENZAPR","TAB 10MG","15","Select","Select",""],["","68180032002","BUPROPN","TAB 300MG XL","30","Select","Select",""],["","00378623201","CITALOPRAM","TAB 20MG","30","Select","Select",""],["","","LO","TAB 40452","","Select","Select",""],["","00378729189","NORETHIN","TAB 5MG","90","Select","Select",""],["","65862077685","MILI","TAB 0.25\/35","84","Select","Select",""],["","70700011985","ESTARYLLA","TAB 0.25-35","84","Select","Select",""],["","64380080707","IBUPROFEN","TAB 800MG","60","Select","Select",""],["","00378668999","PANTOPRAZOLE","TAB 40MG","90","Select","Select",""],["","00472037945","CLOTRIM\/BETA","CRE DIPROP","45","Select","Select",""],["","00406048401","APAP\/CODEINE","TAB 300-30MG","15","Select","Select",""],["","","FLUTICASONE","SPR 50MCG","","Select","Select",""],["","","NORETH\/ETHIN","TAB 43831","","Select","Select",""],["","","METRONIDAZOL","TAB 500MG","","Select","Select",""],["","","NYSTAT\/TRIAM","OIN ","","Select","Select",""],["","00555097302","AMPHET\/DEXTR","TAB 20MG","60","Select","Select",""],["","","TRIAMCINOLON","OIN 0.001","","Select","Select",""],["","","NYSTATIN","OIN 100000","","Select","Select",""],["","00172392670","DIAZEPAM","TAB 5MG","8","Select","Select",""],["","00591505243","PREDNISONE","PAK 5MG","48","Select","Select",""],["","65162010250","GABAPENTIN","CAP 300MG","90","Select","Select",""],["","45802065087","LORATADINE","TAB 10MG","30","Select","Select",""],["","57237000511","FLUCONAZOLE","TAB 150MG","2","Select","Select",""],["","68180071160","CEFDINIR","CAP 300MG","14","Select","Select",""],["","68382050010","OMEPRAZOLE","CAP 40MG","30","Select","Select",""],["","68382031910","TRAMADOL","TAB 50MG","8","Select","Select",""],["","00363002401","ALLERGY","SPR 50MCG","16","Select","Select",""],["","59746000106","METHYLPRED","TAB 4MG","14","Select","Select",""],["","00574402435","ERYTHROMYCIN","OIN 5MG\/GM","4","Select","Select",""],["","57237007810","ONDANSETRON","TAB 8MG ODT","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":""}]}]}