{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JAVERA   D FELTON","gend":1,"add":"58 DALE DR","city":"PORTSMOUTH","state":"VA","zip":"23704-9998","dob":"1993-04-21","age":"","mstatus":"","insh":"2325861*01","cliId":"","pno":"757\/956-8044","cno":"757\/807-8013","email":"","ename":"","eno":"","pphy":"FIELDS-SYKES, KAREN A NP","ppno":"757\/738-1225","pcpadd":"3537 AIRLINE BLVD STE 1","pcpcity":"PORTSMOUTH","pcpstate":"VA","pcpzip":23701,"pcpcounty":"","pcpid":"","pcpname":"AIRLINE BOULEVARD MEDICAL ASSOCIATES","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/488-1037","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["O99.89","O34.219","Z37.0","O70.0","Z87.891","M70.032","S00.12XA","F33.1","Z34.93","N91.1","Z32.01","O60.03","Z3A.33","R45.851","F99.","O23.591","O99.891","B96.89","O99.211","Z3A.08","E66.01","R10.2","R07.9","Z11.3","N76.0","L02.31","O26.893","R10.9","Z3A.37","O34.211","Z3A.38","O99.345","K04.7","B37.9","NO DATA","J04.0","R05.","O99.214","B37.3","Z30.09"],"date":["2020-06-07","2020-07-10","2020-07-11","2020-07-10","2021-11-02","2020-08-27","2021-01-10","2021-06-20","2020-07-09","2020-04-08","2020-04-08","2020-06-07","2020-06-07","2021-07-05","2021-07-05","2021-11-02","2021-11-02","2021-11-02","2021-11-02","2021-11-02","2021-11-02","2021-11-02","2020-09-06","2021-07-07","2021-07-07","2021-12-19","2020-07-01","2020-07-01","2020-07-01","2020-07-11","2020-07-11","2020-07-22","2020-07-22","2020-07-22","2020-07-22","2021-08-26","2021-08-26","2020-07-10","2021-09-30","2021-09-30"],"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":[["","","FLUCONAZOLE","TAB 150MG","","Select","Select",""],["","","FERROUS","TAB 325MG EC","","Select","Select",""],["","","OXYCOD\/APAP","TAB 5-325MG","","Select","Select",""],["","","IBUPROFEN","TAB 600MG","","Select","Select",""],["","","METRONIDAZOL","TAB 500MG","","Select","Select",""],["","","MICONAZOLE","SUP 200MG","","Select","Select",""],["","","AMOX\/K","TAB 875-125","","Select","Select",""],["","","CLINDAMYCIN","CRE 2% VAG","","Select","Select",""],["","","ESCITALOPRAM","TAB 10MG","","Select","Select",""],["","","FEROSUL","TAB 325MG","","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":""}]}]}