{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KRISTA   P ABBOTT","gend":1,"add":"2920 FIRESIDE RD APT G","city":"CHESAPEAKE","state":"VA","zip":"23324-9998","dob":"1976-11-16","age":"","mstatus":"","insh":"2599406*01","cliId":"","pno":"757\/617-8120","cno":"","email":"","ename":"","eno":"","pphy":"SAMUELS, GARFIELD HUE MD","ppno":"757\/518-8823","pcpadd":"4452 CORPORATION LN STE 300","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23462,"pcpcounty":"","pcpid":"","pcpname":"PRIMECARE INTERNAL MEDICINE PC","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/518-8832","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F25.0","L73.2","L81.0","L72.0","E22.1","D35.2","N64.3","A41.9","K55.21","E43.","E87.1","N17.9","D62.","K52.1","Z20.822","H10.33","E87.6","R33.9","I95.9","T36.95XA","Z86.711","Z86.718","D50.9","K92.2","R33.8","D64.9","R19.7","I95.89","E86.1","Z79.01","Z79.2","Z79.811","Z79.891","I82.432","I26.99","F31.9","F20.9","K92.1","E44.0","Z01.419","I82.409","N64.52","K62.5","Q27.33","K61.0","R60.0","I82.402","K64.9","K92.0","E23.7","H04.123","L20.82","Z20.828","M79.606","L02.211","N61.1","N92.0","N92.6","D25.2","L30.1","S13.4XXA","I80.202","L30.4","S33.5XXA","N30.01","K62.89","Z79.899","Z86.72","L20.9","L74.510","H10.413","L02.411","L30.9","S19.9XXA","S29.9XXA"],"date":["2021-10-10","2021-12-31","2021-10-01","2021-11-03","2021-11-23","2021-12-31","2021-11-23","2021-12-31","2021-12-13","2021-12-06","2021-12-31","2021-12-27","2021-12-23","2021-12-06","2021-12-06","2021-12-06","2021-12-06","2021-12-06","2021-12-06","2021-12-06","2021-12-27","2021-12-06","2021-12-31","2021-12-23","2021-12-13","2021-12-27","2021-12-27","2021-12-27","2021-12-27","2021-12-31","2021-12-31","2021-12-31","2021-12-31","2021-08-25","2021-09-01","2021-11-08","2021-11-08","2021-12-11","2021-12-23","2021-07-08","2021-09-15","2021-09-01","2021-12-21","2021-12-27","2021-12-12","2021-08-22","2021-08-22","2021-11-08","2021-12-12","2021-12-30","2021-12-30","2020-01-14","2020-07-14","2021-08-21","2021-12-07","2021-12-07","2020-07-02","2020-07-02","2020-07-02","2020-08-27","2021-08-03","2021-08-21","2021-09-08","2021-11-06","2021-11-06","2021-11-08","2021-11-08","2021-12-20","2020-06-24","2020-06-24","2019-07-24","2019-02-23","2019-07-17","2019-12-13","2019-12-13"],"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":[["","00074012403","HUMIRA","KIT CD\/UC\/HS","3","Select","Select",""],["","","FLUOROMETHOL","SUS 0.1% OP","","Select","Select",""],["","43386009662","CLOBETASOL","OIN 0.0005","60","Select","Select",""],["","52565001829","CLINDAMYCIN","SOL 0.01","30","Select","Select",""],["","59267100002","PFIZER","INJ COVID-19","0","Select","Select",""],["","69238110005","DOXYCYCL","CAP 100MG","20","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","30","Select","Select",""],["","76385012401","METHOCARBAM","TAB 750MG","15","Select","Select",""],["","00168009960","KETOCONAZOLE","CRE 0.02","60","Select","Select",""],["","00904759180","FEROSUL","TAB 325MG","30","Select","Select",""],["","65862044830","VALACYCLOVIR","TAB 500MG","6","Select","Select",""],["","00003376474","ELIQUIS","TAB 5MG","74","Select","Select",""],["","00093101042","MUPIROCIN","OIN 0.02","22","Select","Select",""],["","","NEO\/POLY\/DEX","SUS 0.1% OP","","Select","Select",""],["","00574709012","HYDROCORT","SUP 25MG","12","Select","Select",""],["","59762100501","CABERGOLINE","TAB 0.5MG","24","Select","Select",""],["","53746051501","SPIRONOLACT","TAB 100MG","90","Select","Select",""],["","64380080807","IBUPROFEN","TAB 600MG","20","Select","Select",""],["","68462019005","NAPROXEN","TAB 500MG","20","Select","Select",""],["","43598021040","SSD","CRE 0.01","400","Select","Select",""],["","52817033200","CYCLOBENZAPR","TAB 10MG","15","Select","Select",""],["","63304061650","DOXYCYC","CAP 100MG","47","Select","Select",""],["","65162010250","GABAPENTIN","CAP 300MG","90","Select","Select",""],["","10702001801","OXYCODONE","TAB 5MG","35","Select","Select",""],["","","METRONIDAZOL","TAB 500MG","","Select","Select",""],["","67877012440","SILVER","CRE 0.01","400","Select","Select",""],["","","TOBRADEX","SUS 0.3-0.1%","","Select","Select",""],["","","TOBRA\/DEXAME","SUS 0.3-0.1%","","Select","Select",""],["","00168000680","TRIAMCINOLON","OIN 0.001","80","Select","Select",""],["","","HYDROXYZ","TAB 10MG","","Select","Select",""],["","67405083008","BENZOYL","LIQ 10% WASH","237","Select","Select",""],["","17478029111","CROMOLYN","SOL 4% OP","10","Select","Select",""],["","16252051605","CIPROFLOXACN","TAB 750MG","10","Select","Select",""],["","42858010401","OXYCOD\/APAP","TAB 10-325MG","12","Select","Select",""],["","43386035701","HYDROCO\/APAP","TAB 7.5-325","12","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":""}]}]}