{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"VERLEATRICE LEE","gend":1,"add":"1486 HOLLY POINT RD APT 105","city":"NORFOLK","state":"VA","zip":"23509-9998","dob":"1982-05-13","age":"","mstatus":"","insh":"1198804*01","cliId":"","pno":7573862503,"cno":7573862503,"email":"","ename":"","eno":"","pphy":"NEWBY, JAMES E MD","ppno":7576276892,"pcpadd":"STE 220 930 MAJESTIC AVE,","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":"23504-9998","pcpcounty":"","pcpid":"","pcpname":"Primary Care Specialists","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7576275809,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E66.01","Z68.41","N92.0","N94.5","D64.9","N83.292","R87.610","N71.1","V58.89","M25.522","S50.02XA","M75.112","G89.18","M19.012","I10.","I49.9","G47.30","R10.2","N93.9","Z68.32","K91.2","E66.9","L98.7","Z68.31","Z98.84","S46.212A","M75.42","M25.512","Z68.42","M77.12","L03.114","M75.52","Z20.822","Z32.02","M75.80","R05.","J30.2","G47.33","Z87.891","Z68.30","Z86.39","F41.9","Z68.28","NO DATA","D56.0","Z12.31","F41.1","F33.1","M19.019","L30.9"],"date":["2021-03-23","2021-03-23","2021-12-16","2021-12-16","2021-11-18","2021-12-16","2021-12-01","2021-12-01","2022-04-18","2022-07-08","2022-04-27","2022-12-16","2022-12-16","2023-02-17","2022-12-16","2022-12-16","2022-12-16","2022-01-25","2022-01-25","2022-01-25","2022-09-01","2022-02-01","2022-09-01","2022-04-26","2022-09-01","2022-06-01","2022-12-16","2023-03-10","2021-03-23","2022-04-10","2022-04-10","2022-08-17","2021-01-15","2021-12-16","2022-08-17","2021-02-23","2021-02-23","2021-03-23","2021-03-23","2022-04-27","2022-09-01","2022-09-26","2022-12-06","2023-06-30","2022-09-26","2022-09-26","2022-11-17","2022-11-17","2022-12-06","2023-06-30"],"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":[["","59310057922","PROAIR HFA","AER ","8","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","18","Select","Select",""],["","00781808926","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","70954005940","PREDNISONE","PAK 10MG","48","Select","Select",""],["","00173068220","VENTOLIN HFA","AER ","18","Select","Select",""],["","70000037303","ACETAMINOPHN","TAB 500MG","40","Select","Select",""],["","60505082901","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","00085113201","PROVENTIL","AER HFA","7","Select","Select",""],["","10702001801","OXYCODONE","TAB 5MG","40","Select","Select",""],["","00548560200","ENOXAPARIN","INJ 40\/0.4ML","3","Select","Select",""],["","68462010530","ONDANSETRON","TAB 4MG","6","Select","Select",""],["","42858010201","OXYCOD\/APAP","TAB 5-325MG","28","Select","Select",""],["","65862050220","AMOX\/K CLAV","TAB 500-125","20","Select","Select",""],["","24658031205","DOXYCYCL HYC","TAB 100MG","28","Select","Select",""],["","68382037003","NYSTATIN","POW 100000","60","Select","Select",""],["","50111033401","METRONIDAZOL","TAB 500MG","14","Select","Select",""],["","52817033200","CYCLOBENZAPR","TAB 10MG","15","Select","Select",""],["","65862042005","SMZ\/TMP DS","TAB 800-160","20","Select","Select",""],["","51672140004","CLINDAMYCIN","LOT 0.01","60","Select","Select",""],["","00093005805","TRAMADOL HCL","50 MG","42","Select","Select",""],["","13107005999","APAP\/CODEINE","TAB 300-30MG","15","Select","Select",""],["","00574222545","TRETINOIN","CRE 0.00025","45","Select","Select",""],["","17478071310","OFLOXACIN","DRO 0.3% OP","5","Select","Select",""],["","42806016005","HYDROXYZ HCL","TAB 25MG","90","Select","Select",""],["","61314062810","POLYMYXIN B\/","SOL TRIMETHP","10","Select","Select",""],["","69097083412","SERTRALINE","TAB 50MG","30","Select","Select",""],["","69097094312","GABAPENTIN","CAP 300MG","5","Select","Select",""],["","24208067004","SULFACET SOD","SOL 10% OP","15","Select","Select",""],["","69097083412","SERTRALINE HCL","50 MG","30","Select","Select",""],["","71930002012","HYDROCODONE-ACETAMINOPHEN","7.5-325 MG","28","Select","Select",""],["","10702001801","OXYCODONE HCL","5 MG","28","Select","Select",""],["","50111033401","METRONIDAZOL TAB","500MG","14","Select","Select",""],["","68382037003","NYSTATIN POW","100000","60","Select","Select",""],["","51672128901","NYSTATIN CRE","100000","15","Select","Select",""],["","52817033200","CYCLOBENZAPR TAB","10MG","15","Select","Select",""],["","42858010201","OXYCOD\/APAP TAB","5-325MG","40","Select","Select",""],["","65862042005","SMZ\/TMP DS TAB","800-160","20","Select","Select",""],["","70954005940","PREDNISONE PAK","10MG","48","Select","Select",""],["","13107005999","APAP\/CODEINE TAB","300-30MG","15","Select","Select",""],["","00574222545","TRETINOIN CRE","0.025%","45","Select","Select",""],["","24208067004","SULFACET SOD SOL","10% OP","15","Select","Select",""],["","51672140004","CLINDAMYCIN LOT","1%","60","Select","Select",""],["","17478071310","OFLOXACIN DRO","0.3% OP","5","Select","Select",""],["","00093005805","TRAMADOL HCL TAB","50MG","28","Select","Select",""],["","61314062810","POLYMYXIN B\/ SOL TRIMETHP","","10","Select","Select",""],["","42806016005","HYDROXYZ HCL TAB","25MG","90","Select","Select",""],["","69097083412","SERTRALINE TAB","50MG","30","Select","Select",""],["","69097094312","GABAPENTIN CAP","300MG","5","Select","Select",""],["","10702001801","OXYCODONE TAB","5MG","40","Select","Select",""],["","42806016005","HYDROXYZINE HCL","25 MG","90","Select","Select",""],["","68462011940","FLUCONAZOLE","150 MG","1","Select","Select",""],["","72647033104","METHYLPREDNISOLONE","4 MG","21","Select","Select",""],["","29300041510","CYCLOBENZAPRINE HCL","10 MG","15","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":""}]}]}