{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TAWANIA BRICKHOUSE","gend":1,"add":"605 CREEKSIDE CT","city":"CHESAPEAKE","state":"VA","zip":"23320-9998","dob":"1975-07-25","age":"","mstatus":"","insh":"3407713*01","cliId":"","pno":"757\/893-7198","cno":"757\/893-7198","email":"","ename":"","eno":"","pphy":"ESPINO, STEPHANIE L DO","ppno":"757\/548-0076","pcpadd":"725 VOLVO PKWY STE 100","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":23320,"pcpcounty":"","pcpid":"","pcpname":"Volvo Medical Associates","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/548-1652","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N93.9","D25.9","Z11.3","N76.0","I25.10","R79.89","I12.9","N18.9","E78.5","Z95.5","R60.0","K08.89","M54.2","M54.42","M54.41","E11.9","I25.118","I25.5","Z79.4","H25.13","Q10.0","I25.708","I50.22","I08.8","W19.XXXA","M54.10","I10.","M51.36","M25.519","K04.7","M51.37","B37.9","D47.3"],"date":["2020-04-22","2020-02-18","2020-01-21","2020-01-21","2022-05-05","2020-04-22","2020-01-14","2020-01-14","2020-01-14","2020-07-23","2020-04-22","2020-04-22","2021-09-01","2021-09-01","2021-09-01","2022-05-05","2020-07-23","2020-09-23","2021-06-30","2021-06-30","2021-06-30","2020-01-08","2020-02-26","2020-09-23","2021-06-11","2021-06-29","2022-05-05","2021-06-29","2021-08-05","2021-08-05","2021-08-05","2022-05-05","2022-05-05"],"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":[["","69238110002","DOXYCYCL","CAP 100MG","14","Select","Select",""],["","00002871501","HUMULIN","INJ 70\/30","10","Select","Select",""],["","00186077760","BRILINTA","TAB 90MG","60","Select","Select",""],["","53885027150","ONETOUCH","TES VERIO","50","Select","Select",""],["","53885004401","ONE","KIT VERIO FL","1","Select","Select",""],["","59746021601","SPIRONOLACT","TAB 25MG","30","Select","Select",""],["","49035041412","ASPIRIN","TAB 81MG EC","90","Select","Select",""],["","69452014430","BENZONATATE","CAP 200MG","30","Select","Select",""],["","68645058259","METFORMIN","TAB 500MG","180","Select","Select",""],["","16714079904","CETIRIZINE","TAB 10MG","30","Select","Select",""],["","43547040111","FUROSEMIDE","TAB 20MG","30","Select","Select",""],["","68382009205","CARVEDILOL","TAB 3.125MG","60","Select","Select",""],["","61314062810","POLYMYXIN","SOL TRIMETHP","10","Select","Select",""],["","72205000490","ROSUVASTATIN","TAB 20MG","90","Select","Select",""],["","00310621030","FARXIGA","TAB 10MG","90","Select","Select",""],["","00168020437","LIDOCAINE","OIN 0.05","35","Select","Select",""],["","08290328468","INSULIN","MIS 0.5\/31G","60","Select","Select",""],["","55111014512","FLUCONAZOLE","TAB 150MG","3","Select","Select",""],["","00116200116","CHLORHEX","SOL 0.0012","473","Select","Select",""],["","00143992950","CIPROFLOXACN","TAB 750MG","20","Select","Select",""],["","68645056354","IBUPROFEN","TAB 800MG","30","Select","Select",""],["","63304069301","CLINDAMYCIN","CAP 300MG","30","Select","Select",""],["","00536109194","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","65702072910","ACCU-CHEK","KIT GUIDE","1","Select","Select",""],["","70010010810","GABAPENTIN","CAP 100MG","60","Select","Select",""],["","81131038681","RELION","MIS 31GX8MM","100","Select","Select",""],["","00143924920","AMOX\/K","TAB 875-125","14","Select","Select",""],["","10702000709","CYCLOBENZAPR","TAB 10MG","30","Select","Select",""],["","68645056854","ATORVASTATIN","TAB 40MG","30","Select","Select",""],["","43386016106","MISOPROSTOL","TAB 200MCG","2","Select","Select",""],["","00781261305","AMOXICILLIN","CAP 500MG","28","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":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"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":""}]}]}