{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"STACIE YOUNG","gend":1,"add":"4402 COLUMBIA ST","city":"PORTSMOUTH","state":"VA","zip":"23707-9998","dob":"1978-08-29","age":"","mstatus":"","insh":"1441486*01","cliId":"","pno":7572897987,"cno":7572897987,"email":"","ename":"","eno":"","pphy":"REINEKE-PIPER, KRISTEN MD","ppno":7574883333,"pcpadd":"3925 PORTSMOUTH BLVD","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":"23321-9998","pcpcounty":"","pcpid":"","pcpname":"Family Medicine Healthcare, PLLC","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7574880007,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["C20.","D12.3","K63.5","E03.9","M19.90","Z83.71","Z80.0","K62.5","Z51.11","D50.0","Z20.828","D50.9","K62.89","R50.9","Z68.27","K61.1","G89.3","C18.9","Z12.4","N92.4","K60.4","R00.0"],"date":["2023-04-20","2022-10-19","2022-10-19","2023-01-11","2023-01-11","2022-10-19","2022-10-19","2022-10-19","2023-03-08","2023-04-05","2022-01-07","2023-03-10","2023-01-09","2023-01-09","2023-01-09","2023-01-11","2023-04-05","2022-10-29","2023-01-06","2023-01-06","2023-01-11","2023-04-05"],"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":[["","59267100002","PFIZER VACC","INJ COVID-19","0","Select","Select",""],["","00456045901","ARMOUR THYRO","TAB 60MG","30","Select","Select",""],["","10702001801","OXYCODONE","TAB 5MG","90","Select","Select",""],["","72205002799","ROSUVASTATIN","TAB 5MG","30","Select","Select",""],["","51991096257","POLYETH GLYC","POW 3350 NF","510","Select","Select",""],["","69315091001","DIPHEN\/ATROP","TAB 2.5MG","30","Select","Select",""],["","16729021516","SERTRALINE","TAB 25MG","30","Select","Select",""],["","57237007810","ONDANSETRON","TAB 8MG ODT","40","Select","Select",""],["","42858080201","MORPHINE SUL","TAB 30MG ER","60","Select","Select",""],["","47469000465","MELATONIN","TAB 1-10MG","30","Select","Select",""],["","59746011506","PROCHLORPER","TAB 10MG","32","Select","Select",""],["","52268080003","MIRALAX","POW 3350 NF","527","Select","Select",""],["","50383066730","LIDO\/PRILOCN","CRE 2.5-2.5%","30","Select","Select",""],["","42858010201","OXYCOD\/APAP","TAB 5-325MG","30","Select","Select",""],["","55111016330","OLANZAPINE","2.5 MG","30","Select","Select",""],["","0","COMPOUND"," ","240","Select","Select",""],["","65862007701","CIPROFLOXACIN HCL","500 MG","20","Select","Select",""],["","29300022701","METRONIDAZOLE","500 MG","21","Select","Select",""],["","42858000201","OXYCODONE HCL","10 MG","90","Select","Select",""],["","00093342510","LORAZEPAM","0.5 MG","50","Select","Select",""],["","42858080201","MORPHINE SULFATE ER","30 MG","60","Select","Select",""],["","16729028417","ROSUVASTATIN CALCIUM","5 MG","30","Select","Select",""],["","45802081184","NALOXONE HCL","4 MG","2","Select","Select",""],["","51991096257","POLYETHYLENE GLYCOL","3350 17 G\/DOSE","510","Select","Select",""],["","00456045901","ARMOUR THYROID","60 MG","30","Select","Select",""],["","82607066026","FLOWFLEX COVID-","19 AG HOME TEST","8","Select","Select",""],["","66479058010","ROXICODONE","5 MG","90","Select","Select",""],["","50383066730","LIDOCAINE-PRILOCAINE","2.5 %-2.5%","30","Select","Select",""],["","72205000792","CAPECITABINE","500 MG","120","Select","Select",""],["","50228018010","GABAPENTIN","300 MG","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":""}]}]}