{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"VENESSA   S OUTLAW","gend":1,"add":"7704 ENFIELD AVE APT C7","city":"NORFOLK","state":"VA","zip":"23505-9998","dob":"1992-07-15","age":"","mstatus":"","insh":"5383315*01","cliId":"","pno":"757\/769-6298","cno":"","email":"","ename":"","eno":"","pphy":"BEVERLY, VERNIS MD","ppno":"757\/484-2001","pcpadd":"STE A 3800 POPLAR HILL RD","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":23321,"pcpcounty":"","pcpid":"","pcpname":"Adult and Pediatric Medical Associates","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/484-2182","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z32.01","O21.9","R11.2","O60.00","O26.893","R10.12","Z3A.35","O99.62","K50.90","Z37.0","Z3A.39","O36.63X0","O99.344","O99.892","F41.9","F90.9","O77.0","F32.9","O70.1","O69.81X0","Z82.49","Z91.040","O72.1","Z79.899","J18.9","O14.95","R79.89","N73.9","G89.29","R10.9","M25.579","J30.9","R07.89","Z20.822","S29.9XXA","D64.9","Z01.411","R93.89","O23.42","R10.84","O99.340","K50.919","Z3A.16","O99.89","J02.9","O99.613","K50.10","Z3A.28","O21.2","R50.9","N20.0","R10.32","R94.5","K08.89","T14.90XA","N83.202","R10.2","Z3A.31","Z3A.32","R10.33","K59.00","K21.9","L20.9","R11.0","Z33.1","Z34.00","N12.","R74.01","R10.11","Z87.19","O26.833","O99.013","O15.2","O99.53","J18.8","O10.93","Z20.828","O99.345","R06.02","N92.6","R10.31","R10.817","K58.9","N73.0","N89.8","R05.9","D50.9","R53.83","Z32.00","Z3A.10","Z34.03","Z3A.33","Z23.","M25.571","Z87.42","N94.0","O26.892","R42.","Z3A.19","Z3A.25","Z3A.36","O80.","F41.1","F41.0","R05.","R09.89","K64.8","S93.401A","N94.6","M77.9"],"date":["2020-06-10","2020-06-10","2020-05-04","2020-10-08","2020-10-20","2020-10-20","2020-10-20","2020-11-15","2021-04-27","2020-11-16","2020-11-16","2020-11-16","2020-11-15","2020-11-15","2021-12-07","2021-09-21","2020-11-15","2020-11-15","2020-11-15","2020-11-15","2020-11-15","2021-12-17","2020-11-15","2020-11-15","2020-11-24","2020-11-23","2021-02-16","2021-01-15","2021-05-17","2021-12-07","2021-07-20","2021-10-18","2021-09-20","2021-09-20","2021-09-20","2021-12-17","2021-10-06","2021-10-06","2020-06-07","2020-10-18","2020-06-07","2021-02-15","2020-06-07","2020-09-28","2020-09-01","2020-10-20","2020-09-01","2020-09-01","2020-09-01","2020-09-01","2021-02-23","2021-06-24","2021-02-12","2021-02-23","2021-06-30","2021-07-03","2021-10-21","2020-09-25","2020-09-28","2021-04-29","2021-04-22","2020-07-10","2020-07-10","2021-01-04","2020-11-09","2020-11-09","2020-12-19","2021-02-03","2021-02-03","2021-06-06","2020-10-20","2020-10-26","2020-11-22","2020-11-22","2020-11-22","2020-11-22","2020-12-10","2020-11-22","2020-11-22","2021-04-29","2020-10-18","2020-10-18","2021-04-02","2021-06-24","2021-06-24","2021-12-07","2021-12-17","2021-12-17","2020-05-01","2020-05-01","2020-10-26","2020-10-05","2021-10-18","2021-06-03","2021-06-06","2021-10-21","2020-07-02","2020-07-02","2020-07-02","2020-10-20","2020-10-26","2020-11-16","2020-11-22","2020-11-22","2020-12-10","2020-12-10","2021-04-27","2021-05-27","2021-08-16","2021-11-22"],"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":[["","65162062711","TRAMADOL","TAB 50MG","34","Select","Select",""],["","00591079501","DICYCLOMINE","TAB 20MG","30","Select","Select",""],["","65162083366","DICLOFENAC","GEL 0.01","100","Select","Select",""],["","00904759080","FEROSUL","TAB 325MG","60","Select","Select",""],["","68382009810","PAROXETINE","TAB 20MG","30","Select","Select",""],["","68462019005","NAPROXEN","TAB 500MG","60","Select","Select",""],["","00115180301","HYDROXYZ","CAP 25MG","30","Select","Select",""],["","00406012305","HYDROCO\/APAP","TAB 5-325MG","18","Select","Select",""],["","57237002801","AMOXICILLIN","TAB 500MG","21","Select","Select",""],["","64380080807","IBUPROFEN","TAB 600MG","20","Select","Select",""],["","60432060416","PROMETHAZINE","SYP DM","120","Select","Select",""],["","00093314705","CEPHALEXIN","CAP 500MG","28","Select","Select",""],["","51293061201","PHENAZOPYRID","TAB 200MG","6","Select","Select",""],["","00904672059","ACETAMIN","TAB 500MG","40","Select","Select",""],["","57237007710","ONDANSETRON","TAB 4MG ODT","10","Select","Select",""],["","00406048410","APAP\/CODEINE","TAB 300-30MG","15","Select","Select",""],["","70710122801","AMITRIPTYLIN","TAB 75MG","30","Select","Select",""],["","00143980305","DOXYCYCL","CAP 100MG","28","Select","Select",""],["","63304061650","DOXYCYC","CAP 100MG","20","Select","Select",""],["","00591352530","LIDOCAINE","PAD 0.05","30","Select","Select",""],["","42806071401","BENZONATATE","CAP 100MG","30","Select","Select",""],["","11917009215","FERROUS","TAB 325MG","60","Select","Select",""],["","42192033901","HYOSCYAMINE","SUB 0.125MG","20","Select","Select",""],["","65862050220","AMOX\/K","TAB 500-125","21","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":""}]}]}