{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TAKEIA   D MASON","gend":1,"add":"13213 AQUEDUCT DR APT 6","city":"NEWPORT NEWS","state":"VA","zip":"23602-9998","dob":"1997-10-24","age":"","mstatus":"","insh":"9145400*01","cliId":"","pno":"757\/230-4397","cno":"","email":"","ename":"","eno":"","pphy":"VALERIO, HERNANI A MD","ppno":"757\/930-0091","pcpadd":"12715 WARWICK BOULEVARD STE M O","pcpcity":"NEWPORT NEWS","pcpstate":"VA","pcpzip":23606,"pcpcounty":"","pcpid":"","pcpname":"Commonwealth Family Practice","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/269-4406","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["S09.90XA","Z01.810","R13.10","K22.0","K21.9","E43.","Z48.815","Z43.1","D64.9","Z68.1","Z79.899","K22.8","R11.10","R11.2","R63.3","E46.","R53.1","R42.","F12.90","R63.4","E42.","D50.9","R10.9","E87.6","T78.40XA","R62.7","N92.0","R93.89","R10.30","F17.200","F41.9","Z88.1","Z93.1","Z30.42","F17.209","S01.80XA","S60.212A","S46.912A","R10.13","K08.89","G43.909","Z71.6","F40.241","F17.210","K21.0","Z30.013","Z87.891"],"date":["2020-09-14","2021-01-16","2021-02-03","2021-02-24","2021-02-03","2021-02-03","2021-02-03","2021-02-03","2021-02-03","2021-02-03","2021-02-03","2021-01-06","2021-01-06","2021-01-14","2021-01-14","2021-01-16","2021-01-14","2021-01-14","2021-01-14","2021-01-14","2021-01-14","2021-01-18","2021-01-16","2021-01-18","2021-01-06","2021-01-25","2021-01-18","2021-01-14","2021-01-14","2021-01-14","2021-01-14","2021-01-14","2021-01-25","2021-10-04","2021-01-15","2021-04-13","2020-04-18","2020-04-18","2020-12-10","2019-02-01","2019-12-18","2019-04-02","2019-12-18","2019-04-02","2019-04-02","2019-03-05","2019-12-18"],"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":[["","00363034044","PAIN","SUS 160\/5ML","590","Select","Select",""],["","65862085901","FAMOTIDINE","TAB 20MG","60","Select","Select",""],["","67877032105","IBUPROFEN","TAB 800MG","30","Select","Select",""],["","65862056090","PANTOPRAZOLE","TAB 40MG","60","Select","Select",""],["","00904667840","OXYCODONE","SOL 5MG\/5ML","180","Select","Select",""],["","66689002316","HYDROCO\/APAP","SOL 7.5-325","120","Select","Select",""],["","51672128402","TRIAMCINOLON","OIN 0.001","60","Select","Select",""],["","00116200116","CHLORHEX","SOL 0.0012","473","Select","Select",""],["","66993037083","MEDROXYPR","INJ 150MG\/ML","1","Select","Select",""],["","69543026810","VIRT-PHOS","TAB 250 NEUT","5","Select","Select",""],["","00008084402","PROTONIX","PAK 40MG","30","Select","Select",""],["","","SUCRALFATE","SUS 1GM\/10ML","","Select","Select",""],["","","METRONIDAZOL","TAB 500MG","","Select","Select",""],["","","CYCLOBENZAPR","TAB 5MG","","Select","Select",""],["","68462015813","ONDANSETRON","TAB 8MG ODT","20","Select","Select",""],["","","DOXYCYCL","TAB 100MG","","Select","Select",""],["","","CEPHALEXIN","CAP 500MG","","Select","Select",""],["","","NAPROXEN","TAB 500MG","","Select","Select",""],["","66685100200","AMOX\/K","TAB 500-125","20","Select","Select",""],["","69452015120","VITAMIN","CAP 50000UNT","4","Select","Select",""],["","00555902658","JUNEL","TAB 44581","56","Select","Select",""],["","43547028910","BUPROPION","TAB 150MG SR","60","Select","Select",""],["","13107005999","APAP\/CODEINE","TAB 300-30MG","15","Select","Select",""],["","64380078706","BUSPIRONE","TAB 7.5MG","60","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":""}]}]}