{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KATHERINE CORPREW","gend":1,"add":"2014 COUNTY ST","city":"PORTSMOUTH","state":"VA","zip":"23704-9998","dob":"1986-09-13","age":"","mstatus":"","insh":"4574036*01","cliId":"","pno":"757\/228-6888","cno":"","email":"","ename":"","eno":"","pphy":"KEMENI, ROSINE NP","ppno":"757\/312-6797","pcpadd":"648 GRASSFIELD PKWY STE 1","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":23322,"pcpcounty":"","pcpid":"","pcpname":"CHESAPEAKE REGIONAL MEDICAL GROUP","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/410-0390","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["A04.8","Z87.891","Z80.9","M54.2","NO DATA","Z68.36","M54.5","N62.","M79.7","G89.4","E66.9","M75.41","M75.81","S29.011A","R14.0","R10.13","K21.9","R19.7","R13.10","K31.89","G47.33","G47.21","F32.9","G43.009","M79.601","R51.9","G89.29","R13.19","R68.81","E66.3","K59.00","K52.89","L70.9","L81.9","Z71.9","R30.0","R10.2","N32.81","R10.819","M62.9","R19.8","Z86.19","N39.46","L08.89","Z01.419","L72.9","L01.00","T14.8XXA","Z28.21","M94.0","Z20.828","R20.0","R20.2","Z68.37","N83.209","R10.84","R11.2","S90.512A","S93.402A","M25.511","M54.12","M65.4","M25.531","G56.01","N39.0","R35.0","R19.5","K63.5","R10.9","N76.0","R10.32","G89.18","R39.89","R31.29","M79.18","G43.909","F51.01","E55.9","R73.03","R10.33","Z68.31","J39.2","K20.9","K44.9","L21.9","M65.9","Z68.35","M51.36","M54.16","J45.901","R69.","G43.019","Z00.00","S05.02XA","H00.14","K52.9","K29.50","K29.70","K62.5","D12.2","N95.1","B96.81","F17.200","F40.8","H18.832","R11.0","L30.9","Z86.010","L73.9","R15.2","J30.9","Z11.59","L98.9","R07.9","J01.10","M25.50","J06.9"],"date":["2020-07-24","2021-07-29","2020-05-21","2021-09-23","2021-09-23","2020-10-08","2021-09-23","2021-09-23","2020-10-08","2020-10-08","2021-07-29","2021-09-23","2021-09-23","2021-02-25","2021-03-09","2021-03-09","2021-03-09","2021-03-09","2021-10-28","2021-03-09","2021-07-16","2021-07-16","2021-07-16","2021-07-16","2021-09-23","2021-09-23","2021-09-23","2020-04-27","2020-04-27","2021-10-28","2021-02-03","2021-02-03","2021-04-01","2021-04-01","2021-06-03","2021-07-08","2021-07-08","2021-07-08","2021-10-28","2021-10-28","2021-10-28","2021-10-28","2021-03-04","2021-06-03","2021-07-29","2020-08-14","2020-08-07","2020-08-14","2020-08-07","2021-06-24","2021-06-24","2021-06-25","2021-06-25","2020-01-09","2020-01-15","2020-02-20","2021-09-16","2020-07-23","2020-07-23","2021-01-05","2021-04-15","2021-06-17","2021-06-17","2021-06-17","2021-06-24","2020-01-21","2020-03-25","2020-03-25","2020-08-18","2020-08-18","2020-02-05","2020-02-05","2020-09-09","2020-12-10","2021-05-25","2021-07-29","2021-07-29","2021-07-29","2021-07-29","2021-09-16","2021-09-16","2020-04-23","2020-05-07","2020-05-07","2020-08-14","2019-02-25","2019-11-18","2019-01-03","2019-01-03","2019-01-31","2019-01-31","2019-06-20","2019-07-11","2019-10-31","2019-10-31","2019-01-31","2019-01-31","2019-03-19","2019-10-08","2019-03-19","2019-07-10","2019-10-08","2019-10-08","2019-08-06","2019-01-02","2019-01-29","2019-02-12","2019-06-04","2019-11-21","2019-10-08","2019-10-10","2019-10-10","2019-02-12","2019-01-31","2019-03-08","2019-04-04","2019-05-14"],"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":[["","","MYRBETRIQ","TAB 25MG","","Select","Select",""],["","13107008405","LORAZEPAM","TAB 1MG","2","Select","Select",""],["","69097015907","MELOXICAM","TAB 15MG","90","Select","Select",""],["","10702000710","CYCLOBENZAPR","TAB 10MG","15","Select","Select",""],["","67877057060","DRONABINOL","CAP 10MG","60","Select","Select",""],["","57841115002","TALICIA","CAP ","168","Select","Select",""],["","00168005646","BETAMETH","OIN 0.0005","45","Select","Select",""],["","68682013250","CLINDAM\/BENZ","GEL 1.2-2.5%","50","Select","Select",""],["","","SUCRALFATE","SUS 1GM\/10ML","","Select","Select",""],["","51672136606","CLINDAMY\/BEN","GEL 1.2-5%","45","Select","Select",""],["","69452015120","VITAMIN","CAP 50000UNT","12","Select","Select",""],["","69097012403","TOPIRAMATE","TAB 100MG","30","Select","Select",""],["","43386031208","GAVILAX","POW ","238","Select","Select",""],["","65862039010","ONDANSETRON","TAB 4MG ODT","3","Select","Select",""],["","13668000705","ZOLPIDEM","TAB 5MG","30","Select","Select",""],["","59779030602","CVS","POW ","238","Select","Select",""],["","00116200116","CHLORHEX","SOL 0.0012","473","Select","Select",""],["","","PANTOPRAZOLE","TAB 40MG","","Select","Select",""],["","45802002683","AZELASTINE","SPR 0.0015","30","Select","Select",""],["","00591544310","PREDNISONE","TAB 20MG","21","Select","Select",""],["","00527058610","DICYCLOMINE","CAP 10MG","28","Select","Select",""],["","69097086107","ZONISAMIDE","CAP 100MG","30","Select","Select",""],["","70350261001","SALICYLIC","GEL 0.06","40","Select","Select",""],["","51991036378","RIZATRIPTAN","TAB 10MG ODT","9","Select","Select",""],["","59267100001","PFIZER","INJ COVID-19","0","Select","Select",""],["","00093742698","MONTELUKAST","TAB 10MG","30","Select","Select",""],["","00456120230","LINZESS","CAP 290MCG","90","Select","Select",""],["","43199001101","HYOSCYAMINE","SUB 0.125MG","120","Select","Select",""],["","00093005805","TRAMADOL","TAB 50MG","20","Select","Select",""],["","","HYDROCO\/APAP","TAB 5-325MG","","Select","Select",""],["","","CIPROFLOXACN","TAB 500MG","","Select","Select",""],["","","METHOCARBAM","TAB 750MG","","Select","Select",""],["","","NYSTAT\/TRIAM","OIN ","","Select","Select",""],["","","FLUCONAZOLE","TAB 150MG","","Select","Select",""],["","","DICLOFENAC","TAB 50MG DR","","Select","Select",""],["","","MUPIROCIN","OIN 0.02","","Select","Select",""],["","","DOXYCYCL","TAB 100MG","","Select","Select",""],["","","NAPROXEN","TAB 500MG","","Select","Select",""],["","","HYDROQUINONE","CRE 0.04","","Select","Select",""],["","","ESZOPICLONE","TAB 1MG","","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","67877057305","BENZONATATE","CAP 100MG","20","Select","Select",""],["","65862053820","LEVOFLOXACIN","TAB 750MG","7","Select","Select",""],["","00115521116","COLESTIPOL","TAB 1GM","60","Select","Select",""],["","68382091634","METHYLPRED","TAB 4MG","21","Select","Select",""],["","31722054301","INDOMETHACIN","CAP 50MG","20","Select","Select",""],["","00781185220","AMOX\/K","TAB 875-125","20","Select","Select",""],["","67546011114","ALINIA","TAB 500MG","10","Select","Select",""],["","68180065208","DOXYCYC","CAP 100MG","20","Select","Select",""],["","50111033401","METRONIDAZOL","TAB 500MG","28","Select","Select",""],["","00093310905","AMOXICILLIN","CAP 500MG","28","Select","Select",""],["","55111015810","OMEPRAZOLE","CAP 20MG","28","Select","Select",""],["","69238152301","TETRACYCLINE","CAP 500MG","28","Select","Select",""],["","65649030302","XIFAXAN","TAB 550MG","42","Select","Select",""],["","00378461926","ESTRADIOL","DIS 0.025MG","8","Select","Select",""],["","00574709012","HYDROCORT","SUP 25MG","14","Select","Select",""],["","67877032005","IBUPROFEN","TAB 600MG","20","Select","Select",""],["","67405083506","BENZOYL","LIQ 0.06","170","Select","Select",""],["","13668001990","VENLAFAXINE","CAP 75MG ER","30","Select","Select",""],["","24208091055","ERYTHROMYCIN","OIN OP","4","Select","Select",""],["","00536120215","LIDOCAINE","PAD 0.04","10","Select","Select",""],["","51672135708","FLUOCIN","OIL 0.01% SC","118","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":""}]}]}