{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LORI   A KROENER","gend":1,"add":"4105 NEWPORT AVE","city":"NORFOLK","state":"VA","zip":"23508-9998","dob":"1969-08-08","age":"","mstatus":"","insh":"2240630*01","cliId":"","pno":"757\/237-8006","cno":"","email":"","ename":"","eno":"","pphy":"DERBER, PAUL MD","ppno":"757\/481-1113","pcpadd":"SUITE 201 1168 FIRST COLONIAL R","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23454,"pcpcounty":"","pcpid":"","pcpname":"First Colonial Medical Associates","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/496-3822","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z01.419","G62.9","K21.9","N92.1","J30.89","F90.0","R30.0","R32.","D25.1","N83.02","Z12.11","K57.30","K21.0","K44.9","H31.092","H52.13","H52.221","H52.4","NO DATA","K29.70","M54.2","M54.5","G89.29","Z68.24","F32.1","F90.2","R07.9","I10.","I47.1","R19.7","Z12.39","K59.00","F41.8","Z63.8","Z01.812","Z20.822","N94.89","Z01.810","Z01.818","Z51.81","F98.8","M12.9","F32.9","G43.909","Z80.3","Z88.0","Z88.5","Z81.8","Z83.3","Z82.0","Z82.49","Z82.61","Z79.899","E87.5","F31.32","Z23.","H52.223","H90.3","R12.","I51.89","R10.9","K62.89","L30.9","M25.50","H83.2X2","Z00.00"],"date":["2021-09-01","2020-09-23","2021-10-25","2021-10-25","2021-10-25","2021-10-25","2021-10-25","2021-10-25","2020-01-17","2020-01-17","2020-02-27","2020-02-27","2020-04-27","2021-07-19","2021-12-13","2021-12-13","2020-12-09","2021-12-13","2021-04-06","2021-01-18","2021-11-02","2021-09-16","2021-09-16","2021-09-16","2021-10-29","2021-12-15","2021-11-18","2021-10-07","2021-10-07","2020-04-27","2021-09-01","2020-01-15","2021-06-25","2021-03-17","2021-07-15","2021-03-19","2021-06-25","2021-07-15","2021-07-15","2021-07-15","2021-07-16","2021-07-16","2021-07-16","2021-07-16","2021-07-16","2021-07-16","2021-07-16","2021-07-16","2021-07-16","2021-07-16","2021-07-16","2021-07-16","2021-07-16","2021-07-16","2021-12-15","2021-10-25","2021-12-13","2021-12-16","2021-01-18","2021-11-18","2020-07-09","2020-07-09","2020-07-09","2020-07-09","2021-12-16","2019-12-12"],"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":[["","","BUPROPN"," BUPROPN ","30","Select","Select",""],["","","CLONAZEPAM"," CLONAZEPAM ","60","Select","Select",""],["","","TRAZODONE"," TRAZODONE ","30","Select","Select",""],["","","VENLAFAXINE","CAP 75MG ER","","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","6","Select","Select",""],["","63739019861","PEG","POW ","30","Select","Select",""],["","45802095243","IBUPROFEN","SUS 100\/5ML","473","Select","Select",""],["","00904667840","OXYCODONE","SOL 5MG\/5ML","200","Select","Select",""],["","","AMPHET\/DEXTR","TAB 20MG","","Select","Select",""],["","00185012201","NITROFURANTN","CAP 100MG","14","Select","Select",""],["","","OMEPRAZOLE","CAP 40MG","","Select","Select",""],["","","FAMOTIDINE","TAB 40MG","","Select","Select",""],["","","PANTOPRAZOLE","TAB 40MG","","Select","Select",""],["","","LANSOPRAZOLE","CAP 30MG DR","","Select","Select",""],["","","CLOTRIM\/BETA","CRE DIPROP","","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":""}]}]}