{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BRINA   J BRUNELL","gend":1,"add":"3866 STAFFORDSHIRE LN","city":"WILLIAMSBURG","state":"VA","zip":"23188-9998","dob":"1990-05-29","age":"","mstatus":"","insh":"2301983*01","cliId":"","pno":"732\/687-8250","cno":"732\/687-8250","email":"","ename":"","eno":"","pphy":"FEROZE, AMNA H MD","ppno":"757\/345-0011","pcpadd":"7364 RICHMOND RD","pcpcity":"WILLIAMSBURG","pcpstate":"VA","pcpzip":23188,"pcpcounty":"","pcpid":"","pcpname":"Riverside Primary Care Norge","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/345-0381","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["H93.8X3","R20.2","G93.9","Q79.60","F17.210","Z71.6","G35.","Z72.0","J30.2","J06.9","F90.0","E55.9","D50.8","B07.8","F43.10","F32.2","F41.1","F43.20","N92.0","F41.9","F32.9","R00.0","R51.9","Z09.","M62.838","R07.89","R07.9","D50.9","F90.9","Z82.0","G97.1","Z88.8","Z91.040","Z79.899","M25.461","H65.193","R53.82","Z87.891","F90.2","F32.0","R20.8","K04.7","Z82.69","H92.02","Z91.018","R20.0","R03.0","Z53.29","M79.2","R90.89","R52.","R55.","R42.","H53.8","Z00.00","H04.121","H04.122","NO DATA","Z01.419","Z71.2"],"date":["2020-07-13","2021-05-28","2020-10-16","2020-10-19","2022-06-07","2020-10-16","2021-10-31","2020-10-19","2021-06-25","2021-01-15","2022-11-02","2021-06-25","2021-06-25","2021-01-15","2022-11-02","2022-11-02","2022-11-02","2020-11-20","2021-06-25","2021-10-31","2021-06-25","2021-06-25","2022-06-07","2020-10-22","2020-10-22","2021-10-31","2021-11-06","2020-10-15","2022-06-07","2020-10-15","2020-10-15","2022-06-07","2022-06-07","2022-06-07","2020-10-15","2020-06-16","2020-06-16","2020-06-16","2020-11-24","2020-11-24","2020-10-15","2020-10-15","2020-10-15","2021-05-28","2022-06-07","2022-06-07","2021-10-31","2021-10-31","2020-10-30","2020-11-12","2020-10-20","2020-10-20","2020-10-20","2020-10-20","2021-10-07","2020-07-14","2020-07-14","2020-07-14","2020-08-28","2020-08-28"],"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":[["","00527150237","AMPHET\/DEXTR","TAB 10MG","60","Select","Select",""],["","80777027399","MODERNA","INJ COVID-19","0","Select","Select",""],["","31722070530","VALACYCLOVIR","TAB 1GM","21","Select","Select",""],["","57844012001","ADDERALL","TAB 20MG","60","Select","Select",""],["","58468021104","AUBAGIO","TAB 7MG","30","Select","Select",""],["","64380073706","VITAMIN","CAP 50000UNT","12","Select","Select",""],["","68180016113","AZITHROMYCIN","TAB 500MG","5","Select","Select",""],["","60505264807","TIZANIDINE","CAP 2MG","90","Select","Select",""],["","45802065078","LORATADINE","TAB 10MG","30","Select","Select",""],["","59267100002","PFIZER","INJ COVID-19","0","Select","Select",""],["","00395052798","CHARCOAL","POW ","1135","Select","Select",""],["","27241013436","CHOLESTYRAM","POW 4GM","42","Select","Select",""],["","10370010250","BUPROPN","TAB 300MG XL","30","Select","Select",""],["","00093742698","MONTELUKAST","TAB 10MG","30","Select","Select",""],["","00065853302","CIPRODEX","SUS 0.3-0.1%","8","Select","Select",""],["","69097081312","GABAPENTIN","CAP 100MG","90","Select","Select",""],["","65162062711","TRAMADOL","TAB 50MG","10","Select","Select",""],["","13668013601","ESCITALOPRAM","TAB 10MG","30","Select","Select",""],["","00228141003","LAMOTRIGINE","TAB 25MG ER","30","Select","Select",""],["","57896070310","IRON","TAB 325MG","30","Select","Select",""],["","69097084507","CYCLOBENZAPR","TAB 5MG","60","Select","Select",""],["","49281042050","FLUZONE","INJ 2020-21","0","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":""}]}]}