{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"REGINA   A BENN","gend":1,"add":"523 TIMOTHY AVE APT C","city":"NORFOLK","state":"VA","zip":"23505-9998","dob":"1987-02-15","age":"","mstatus":"","insh":"2252309*01","cliId":"","pno":"757-389-3561","cno":"757-389-3561","email":"","ename":"","eno":"","pphy":"WOOD, JESSICA V NP","ppno":"757\/622-8358","pcpadd":"930 W 21ST ST SUITE 100","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23517,"pcpcounty":"","pcpid":"","pcpname":"BON SECOURS GHENT STATION MEDICAL ASSOCIATES","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/622-9662","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R06.89","J45.41","F17.210","J45.901","Z87.891","R06.9","Z20.822","Z88.6","Z91.013","R05.9","R50.9","R53.81","R11.0","J45.51","R06.02","J45.21","O03.4","N93.9","Z33.2","Z76.0","Z79.51","Z79.899","J45.909","J45.50","R07.9","J45.52","R09.02","R00.0","J45.31","B34.9","I49.9","R07.89","R06.03","O73.0","J45.40","O02.1","Z87.59","R06.2","R06.82","R07.0","R12.","J96.01","K08.89","O72.0","Z3A.12","O99.511","O99.331","O09.521","V23.41","O34.211","Z79.3","R10.9","F17.200","I10."],"date":["2022-04-13","2022-10-01","2022-10-01","2022-09-22","2022-11-18","2020-09-16","2022-11-12","2022-10-01","2022-10-01","2022-08-01","2022-10-01","2022-11-12","2022-11-12","2022-05-04","2022-09-13","2022-10-31","2022-08-23","2022-08-22","2022-08-22","2022-09-13","2022-09-02","2022-09-02","2022-11-18","2022-11-23","2020-09-16","2022-04-13","2022-04-13","2022-04-13","2022-07-28","2022-10-31","2022-11-12","2020-09-14","2022-09-22","2022-08-30","2022-10-13","2022-08-23","2022-08-30","2020-07-12","2022-03-23","2020-08-17","2020-08-17","2020-09-17","2021-05-14","2022-08-23","2022-08-23","2022-08-23","2022-08-23","2022-08-23","2022-08-23","2022-08-23","2022-08-23","2022-08-23","2022-04-11","2022-04-11"],"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":[]},{"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":[["","00378334053","XULANE","DIS 150-35","3","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","8","Select","Select",""],["","00591544201","PREDNISONE","TAB 10MG","75","Select","Select",""],["","69238110005","DOXYCYCL","CAP 100MG","14","Select","Select",""],["","70010016201","LORATADINE","TAB 10MG","28","Select","Select",""],["","70677003101","SM","DIS 14MG\/24H","30","Select","Select",""],["","00487020103","IPRATROPIUM\/","SOL ALBUTER","90","Select","Select",""],["","66993058597","FLUTIC\/SALME","AER 250\/50","60","Select","Select",""],["","62175011843","OMEPRAZOLE","CAP 20MG","60","Select","Select",""],["","00904759080","FEROSUL","TAB 325MG","12","Select","Select",""],["","00173069700","ADVAIR","AER 500\/50","60","Select","Select",""],["","68180087773","JENCYCLA","TAB 0.35MG","84","Select","Select",""],["","65862057490","MONTELUKAST","TAB 10MG","30","Select","Select",""],["","42192032090","PNV-SELECT","TAB ","90","Select","Select",""],["","66993007996","FLUTICAS","AER 110MCG","12","Select","Select",""],["","00173071920","FLOVENT","AER 110MCG","12","Select","Select",""],["","00173088710","TRELEGY","AER 100MCG","60","Select","Select",""],["","65862039010","ONDANSETRON","TAB 4MG ODT","12","Select","Select",""],["","00378932232","WIXELA","AER 500\/50","60","Select","Select",""],["","00093117401","PENICILLN","TAB 500MG","28","Select","Select",""],["","65628005001","FIRST-MOUTHW","SUS BLM","237","Select","Select",""],["","65162046510","IBUPROFEN","TAB 600MG","20","Select","Select",""],["","11822506040","ACETAMIN","TAB 500MG","21","Select","Select",""],["","31722094101","HYDROCO\/APAP","TAB 5-325MG","6","Select","Select",""],["","00093310953","AMOXICILLIN","CAP 500MG","12","Select","Select",""],["","65162035803","ZAFEMY","DIS 150\/35","9","Select","Select",""],["","65862018601","CLINDAMYCIN","CAP 300MG","21","Select","Select",""],["","11822046713","PAIN","TAB 325MG","30","Select","Select",""],["","00116200116","CHLORHEX","SOL 0.0012","473","Select","Select",""],["","11822505390","RA","TAB 10MG","14","Select","Select",""],["","00173068220","VENTOLIN","AER ","18","Select","Select",""],["","00054418325","DEXAMETHASON","TAB 2MG","5","Select","Select",""],["","60758011905","PREDNISOLONE","SUS 1% OP","5","Select","Select",""],["","00456315467","AEROCHAMBER","MIS PLUS","1","Select","Select",""],["","00093598627","EPINEPHRINE","INJ 0.3MG","2","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":""}]}]}