{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"NADIA ADAMS","gend":1,"add":"612 BOTTOM QUAY","city":"CHESAPEAKE","state":"VA","zip":"23320-9998","dob":"1986-05-30","age":"","mstatus":"","insh":"2213691*01","cliId":"","pno":"757\/323-1467","cno":"757\/323-1467","email":"","ename":"","eno":"","pphy":"GOLPIRA, ELIZABETH MD","ppno":"757\/793-4710","pcpadd":"850 KEMPSVILLE RD SUITE 100A","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23502,"pcpcounty":"","pcpid":"","pcpname":"MAWC - Womancare Centers, PLC","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/904-3694","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J34.89","J30.2","J30.1","F33.1","F41.1","R09.81","J32.8","H53.8","J06.9","R59.9","Z01.419","Z30.432","J34.2","J35.1","J34.3","J01.10","J45.20","H11.31","E88.81","J70.9","H11.30","R21.","H10.10","T78.40XA","B30.9"],"date":["2021-07-01","2021-03-29","2022-04-11","2021-02-01","2021-02-01","2021-07-01","2021-07-01","2021-06-03","2021-06-03","2021-06-03","2020-12-23","2020-12-23","2020-01-29","2020-01-21","2020-01-21","2020-04-24","2020-04-24","2020-04-24","2020-11-01","2021-07-01","2020-04-20","2021-03-13","2021-04-18","2021-04-18","2021-04-26"],"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":[["","00228306211","AMPHET\/DEXTR","CAP 5MG ER","30","Select","Select",""],["","54092038101","ADDERALL","CAP 5MG","30","Select","Select",""],["","00555077902","MEDROXYPR","TAB 10MG","7","Select","Select",""],["","00456114030","VIIBRYD","TAB 40MG","30","Select","Select",""],["","68462010340","FLUCONAZOLE","TAB 150MG","2","Select","Select",""],["","33342020010","LEVOCETIRIZI","TAB 5MG","30","Select","Select",""],["","60505084805","AZELASTINE","SPR 0.0015","90","Select","Select",""],["","65862057490","MONTELUKAST","TAB 10MG","90","Select","Select",""],["","17478007031","ERYTHROMYCIN","OIN 5MG\/GM","10","Select","Select",""],["","00093101042","MUPIROCIN","OIN 0.02","22","Select","Select",""],["","10592000101","PONARIS","SOL ","30","Select","Select",""],["","60432026415","FLUTICASONE","SPR 50MCG","48","Select","Select",""],["","00781106101","ALPRAZOLAM","TAB 0.25MG","30","Select","Select",""],["","68180071160","CEFDINIR","CAP 300MG","10","Select","Select",""],["","62332050503","MOXIFLOXACIN","SOL HCL 0.5%","3","Select","Select",""],["","00093506201","HYDROXYZ","TAB 50MG","30","Select","Select",""],["","00093406701","PRAZOSIN","CAP 1MG","91","Select","Select",""],["","50111064701","FLUOXETINE","CAP 10MG","30","Select","Select",""],["","65862052790","VENLAFAXINE","CAP 37.5 ER","35","Select","Select",""],["","00591024005","LORAZEPAM","TAB 0.5MG","30","Select","Select",""],["","00093031401","KETOROLAC","TAB 10MG","20","Select","Select",""],["","59746000103","METHYLPRED","TAB 4MG","21","Select","Select",""],["","31722094101","HYDROCO\/APAP","TAB 5-325MG","10","Select","Select",""],["","69621081200","TICALAST","KIT 137\/50","1","Select","Select",""],["","11822061559","BUDESONIDE","SUS NASAL","25","Select","Select",""],["","57237000830","MIRTAZAPINE","TAB 15MG","30","Select","Select",""],["","69238110005","DOXYCYCL","CAP 100MG","14","Select","Select",""],["","68180031906","BUPROPN","TAB 150MG XL","30","Select","Select",""],["","50580064602","RHINOCORT","SUS ALLERGY","25","Select","Select",""],["","65162027210","SMZ\/TMP","TAB 800-160","14","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","8","Select","Select",""],["","16729020201","BUSPIRONE","TAB 10MG","60","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":""}]}]}