{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MARY TRIPP","gend":1,"add":"3801 BOWSPRIT CIR APT 104","city":"VIRGINIA BEACH","state":"VA","zip":"23453-9998","dob":"1989-07-11","age":"","mstatus":"","insh":"3553590*01","cliId":"","pno":"757\/289-6256","cno":"","email":"","ename":"","eno":"","pphy":"CHASTANET, RACHEL I MD","ppno":"757\/312-9444","pcpadd":"221 MT PLEASANT RD SUITE A-1","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":23322,"pcpcounty":"","pcpid":"","pcpname":"CHESAPEAKE WEIGHT LOSS CONSULTANTS PLLC","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/447-3500","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["O34.211","Z00.00","J45.20","J30.9","E66.01","R73.03","Z11.3","Z12.4","Z72.0","N91.2","Z68.42","V23.9","O35.9XX0","O99.213","Z3A.32","O60.14X0","Z3A.35","Z37.0","R73.09","E78.6","E55.9","V23.89","O35.0XX0","Z3A.33","R00.0","M54.5","J45.909","Z68.41","D50.9","K59.00","R11.10","Z32.01","N92.5","J45.21","F17.210","T78.40XA","R21.","Z3A.28","Z23.","R07.81","J40.","F17.200","Z83.3","E78.5","G44.209","R05.","Z20.828","R53.83","Z20.822","J02.9","G47.00","R10.2","R10.31","R11.2","N76.0","H20.9","M79.661","J98.8","O99.212","Z3A.26","O99.214","O99.52","O99.334","Z30.014","Z28.21","Z79.899","Z86.32","Z87.51","O80.","Z30.017","G89.18"],"date":["2020-03-02","2019-06-18","2019-06-18","2019-06-18","2021-07-08","2021-06-14","2019-06-18","2019-06-18","2020-02-02","2019-07-24","2020-06-09","2020-02-05","2020-02-05","2020-02-18","2020-02-05","2020-03-02","2020-03-02","2020-03-02","2021-07-08","2021-07-08","2021-07-08","2020-02-18","2020-02-18","2020-02-18","2020-08-31","2020-08-14","2020-07-17","2020-08-31","2021-06-14","2021-06-14","2019-07-24","2019-07-31","2019-08-23","2019-12-27","2020-03-02","2020-09-02","2020-09-02","2020-01-08","2020-01-08","2020-02-02","2020-08-06","2020-08-06","2020-08-14","2020-08-31","2020-12-16","2021-06-08","2020-12-16","2020-06-09","2021-06-08","2021-06-08","2021-06-14","2019-02-07","2019-04-29","2019-04-29","2019-08-16","2021-04-29","2021-12-02","2019-12-27","2019-12-27","2019-12-27","2020-03-02","2020-03-02","2020-03-02","2020-03-02","2020-03-02","2020-03-02","2020-03-02","2020-03-02","2020-03-02","2020-03-04","2020-03-03"],"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":[["","","ONDANSETRON"," ONDANSETRON ","12","Select","Select",""],["","","CETIRIZINE"," CETIRIZINE ","30","Select","Select",""],["","","CITRANATAL"," CITRANATAL ","60","Select","Select",""],["","","VENTOLIN"," VENTOLIN ","18","Select","Select",""],["","","PROAIR"," PROAIR ","8","Select","Select",""],["","","METRONIDAZOL"," METRONIDAZOL ","30","Select","Select",""],["","","DICYCLOMINE"," DICYCLOMINE ","15","Select","Select",""],["","","CLOTRIM\/BETA"," CLOTRIM\/BETA ","45","Select","Select",""],["","","ALBUTEROL"," ALBUTEROL ","18","Select","Select",""],["","","PREDNISONE"," PREDNISONE ","30","Select","Select",""],["","","CALCIUM","TAB 600MG","","Select","Select",""],["","","DOK","CAP 100MG","","Select","Select",""],["","","IBUPROFEN","TAB 800MG","","Select","Select",""],["","","PHENTERMINE","TAB 37.5MG","","Select","Select",""],["","","EPINEPHRINE","INJ 0.3MG","","Select","Select",""],["","","FEROSUL","TAB 325MG","","Select","Select",""],["","","HYDROCO\/APAP","TAB 5-325MG","","Select","Select",""],["","","PAIN","TAB 500MG","","Select","Select",""],["","","PRENATAL","TAB LOW IRON","","Select","Select",""],["","","POLYETH","POW 3350 NF","","Select","Select",""],["","","TOPIRAMATE","TAB 25MG","","Select","Select",""],["","","FAMOTIDINE","TAB 20MG","","Select","Select",""],["","","HYDROXYZ","TAB 25MG","","Select","Select",""],["","","TRAZODONE","TAB 100MG","","Select","Select",""],["","","BENZONATATE","CAP 100MG","","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":""}]}]}