{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"AMANDA DETERMAN","gend":1,"add":"2813 WILLOW WOOD DR DR","city":"CHESAPEAKE","state":"VA","zip":"23323-9998","dob":"1981-06-16","age":"","mstatus":"","insh":"2274685*01","cliId":"","pno":"757\/373-8756","cno":"","email":"","ename":"","eno":"","pphy":"PATEL, SONAL MD","ppno":"757\/312-6267","pcpadd":"908 EDEN WAY N STE 101","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":23320,"pcpcounty":"","pcpid":"","pcpname":"CHESAPEAKE REGIONAL MEDICAL GROUP","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/819-7185","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["H92.03","C18.7","C19.","Z80.0","E66.9","F41.9","N13.30","C18.9","F41.8","Z00.00","Z68.41","E66.01","N84.0","N83.201","Z53.31","Z88.5","Z98.891","Z80.49","Z12.4","N93.9","K13.79","Z51.11","D50.9","F43.21","Z85.048","Z01.419","H93.293","G47.33","D51.0","G60.9","Z30.432","Z85.038","D64.9","C77.2","Z90.49","Z79.899","K22.8","K31.7","K29.80","Z45.2","Z92.21","Z01.818","G63.","Z20.822","J18.9","H65.90","Z23.","Z30.430","Z11.3","Z32.02","N83.202","R59.0","Z98.890","E11.9","Z51.12","Z12.11","G47.30","R53.83","R63.0","R11.0","R11.2","R68.84","R07.9","R06.00"],"date":["2022-02-14","2022-11-15","2020-10-29","2022-10-06","2021-11-10","2020-10-05","2022-02-03","2022-10-06","2021-12-27","2021-06-03","2022-09-19","2022-09-19","2022-01-25","2022-02-03","2020-02-26","2022-09-19","2020-02-26","2021-12-06","2020-02-26","2022-01-25","2020-03-21","2022-11-08","2022-03-25","2020-07-06","2022-03-10","2021-03-26","2021-05-19","2022-11-04","2020-11-12","2022-11-04","2021-05-05","2022-10-19","2022-09-19","2022-09-19","2022-09-19","2022-09-19","2020-02-05","2020-02-05","2020-02-05","2020-04-29","2022-08-26","2022-01-12","2020-11-18","2021-07-31","2021-07-31","2020-10-05","2020-10-05","2021-05-03","2021-05-03","2021-05-03","2022-02-03","2022-09-19","2022-08-03","2022-10-19","2022-11-08","2022-10-19","2022-10-19","2022-10-31","2022-10-31","2022-10-31","2022-10-31","2022-11-10","2022-11-10","2022-11-22"],"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":[["","70010010801","GABAPENTIN","CAP 100MG","90","Select","Select",""],["","51672530606","FLUOXETINE","TAB 60MG","90","Select","Select",""],["","68462015813","ONDANSETRON","TAB 8MG ODT","30","Select","Select",""],["","50383066730","LIDO\/PRILOCN","CRE 2.5-2.5%","30","Select","Select",""],["","00555077902","MEDROXYPR","TAB 10MG","30","Select","Select",""],["","00378728353","NORETH\/ETHIN","TAB FE 1\/20","28","Select","Select",""],["","70436001104","BUPROPN","TAB 300MG XL","90","Select","Select",""],["","68462011944","FLUCONAZOLE","TAB 150MG","1","Select","Select",""],["","65862060130","MODAFINIL","TAB 100MG","60","Select","Select",""],["","68462029817","CLOTRIM\/BETA","CRE DIPROP","15","Select","Select",""],["","23155050101","HYDROXYZ","TAB 25MG","120","Select","Select",""],["","51672129303","CLOBETASOL","SOL 0.0005","50","Select","Select",""],["","00781286810","OMEPRAZOLE","CAP 20MG DR","30","Select","Select",""],["","11822029233","RA","TAB 5MG EC","4","Select","Select",""],["","00832059011","DIPHEN\/ATROP","TAB ","30","Select","Select",""],["","59746011506","PROCHLORPER","TAB 10MG","30","Select","Select",""],["","00591024110","LORAZEPAM","TAB 1MG","30","Select","Select",""],["","00591079501","DICYCLOMINE","TAB 20MG","20","Select","Select",""],["","45802075930","PROMETHAZINE","SUP 25MG","15","Select","Select",""],["","00065853302","CIPRODEX","SUS 0.3-0.1%","8","Select","Select",""],["","23155019101","BUPROPION","TAB 75MG","30","Select","Select",""],["","43598032675","CIPRO\/DEXA","SUS 0.3-0.1%","8","Select","Select",""],["","69367016204","PHENAZOPYRID","TAB 100MG","15","Select","Select",""],["","65162046510","IBUPROFEN","TAB 600MG","90","Select","Select",""],["","00116200116","CHLORHEX","SOL 0.0012","946","Select","Select",""],["","11822300930","SENNA","TAB 8.6-50MG","60","Select","Select",""],["","51660093901","CETIRIZINE","TAB 10MG","90","Select","Select",""],["","11822489200","ANTI-DIARRHE","CAP 2MG","24","Select","Select",""],["","65162047810","NITROFURANTN","CAP 100MG","10","Select","Select",""],["","00574722612","COMPRO","SUP 25MG","15","Select","Select",""],["","00713063437","MOMETASONE","CRE 0.001","45","Select","Select",""],["","60432026415","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","59267100001","PFIZER","INJ COVID-19","0","Select","Select",""],["","16714040604","LARIN","TAB 43831","28","Select","Select",""],["","50111033401","METRONIDAZOL","TAB 500MG","2","Select","Select",""],["","50383056510","NEOMYCIN","TAB 500MG","4","Select","Select",""],["","65162004710","OXYCODONE","TAB 5MG","10","Select","Select",""],["","00023485745","VANIQA","CRE 0.139","45","Select","Select",""],["","00548560200","ENOXAPARIN","INJ 40\/0.4ML","11","Select","Select",""],["","65862052790","VENLAFAXINE","CAP 37.5 ER","30","Select","Select",""],["","00378427693","VALACYCLOVIR","TAB 1GM","14","Select","Select",""],["","48582015942","BIOTENE","LOZ MOUTH","90","Select","Select",""],["","52536008014","CIPRO\/FLUOC","DRO PF","14","Select","Select",""],["","00093220301","METOCLOPRAM","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":""}]}]}