{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ISIS ROBINSON","gend":1,"add":"744 STANWIX SQ","city":"NORFOLK","state":"VA","zip":"23502-9998","dob":"1986-11-20","age":"","mstatus":"","insh":"7672373*01","cliId":"","pno":"757\/770-7939","cno":"757\/770-7939","email":"","ename":"","eno":"","pphy":"ELHASSAN, AMIRA S MD","ppno":"757\/738-1300","pcpadd":"4421 VIRGINIA BEACH BLVD STE 114","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23462,"pcpcounty":"","pcpid":"","pcpname":"BON SECOURS MEDICAL ASSOCIATES","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/687-3202","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["U07.1","R50.9","R05.","J96.01","J12.89","A41.9","E87.6","F17.210","L40.0","Z71.9","T23.162A","T24.112A","E66.01","Z68.41","M79.652","Z41.1","N92.6","M54.9","N62.","M25.512","M25.511","M41.35","L30.9","L40.9","Z28.21","J96.00","Z72.0","Z00.00","H92.02","H60.12","E66.9","L70.0","L73.0","K13.0","B35.4","L98.9","B35.0","Z32.02","A41.89","J40.","K76.0","R04.0","Z71.6","Z79.1","Z79.899","Z82.49","Z12.4"],"date":["2020-07-16","2020-07-05","2020-07-05","2020-07-13","2020-07-16","2020-07-13","2020-07-13","2020-07-13","2021-01-15","2021-01-15","2022-04-27","2022-04-27","2022-09-12","2022-10-12","2022-04-27","2022-08-02","2020-08-25","2022-09-12","2022-09-12","2022-09-12","2022-09-12","2022-09-12","2022-10-12","2022-10-12","2020-06-08","2020-07-10","2020-07-10","2022-04-04","2022-10-12","2022-10-12","2022-10-12","2020-06-08","2020-06-08","2020-06-08","2020-01-13","2020-02-13","2020-02-13","2020-09-14","2020-07-10","2020-07-10","2020-07-10","2020-07-10","2020-07-10","2020-07-10","2020-07-10","2020-07-10","2022-05-23"],"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":[["","52817033010","CYCLOBENZAPR","TAB 5MG","60","Select","Select",""],["","45802006001","BACITRACIN","OIN 500\/GM","14","Select","Select",""],["","68462019005","NAPROXEN","TAB 500MG","60","Select","Select",""],["","51672128202","TRIAMCINOLON","CRE 0.001","30","Select","Select",""],["","00781185220","AMOX\/K","TAB 875-125","20","Select","Select",""],["","68682011001","PIMECROLIMUS","CRE 0.01","30","Select","Select",""],["","68462053435","TACROLIMUS","OIN 0.001","30","Select","Select",""],["","68462050165","CALCIPOTRIEN","CRE 0.00005","60","Select","Select",""],["","53489011802","DOXYCYCL","CAP 50MG","60","Select","Select",""],["","00713072853","BETAMETH","LOT 0.0005","60","Select","Select",""],["","00168009915","KETOCONAZOLE","CRE 0.02","15","Select","Select",""],["","68462018117","CLOTRIMAZOLE","CRE 0.01","15","Select","Select",""],["","57237000430","FLUCONAZOLE","TAB 100MG","10","Select","Select",""],["","45802001402","HYDROCORT","OIN 0.025","20","Select","Select",""],["","00187516245","RETIN-A","CRE 0.0005","45","Select","Select",""],["","00378808345","TRETINOIN","CRE 0.0005","45","Select","Select",""],["","64380071306","BENZONATATE","CAP 200MG","30","Select","Select",""],["","00904672059","ACETAMIN","TAB 500MG","30","Select","Select",""],["","50580044936","TYLENOL","TAB 500MG","30","Select","Select",""],["","70677004901","SM","TAB 600MG ER","60","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","18","Select","Select",""],["","59310057922","PROAIR","AER ","8","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":""}]}]}