{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BRITNY DOUGLAS","gend":1,"add":"13465 HIGH GATE MEWS","city":"CARROLLTON","state":"VA","zip":"23314-9998","dob":"1988-07-18","age":"","mstatus":"","insh":"1482810*01","cliId":"","pno":7572541395,"cno":7572541395,"email":"","ename":"","eno":"","pphy":"WENG, JESSICA MD","ppno":7578501311,"pcpadd":"19D FOX HILL RD,","pcpcity":"HAMPTON","pcpstate":"VA","pcpzip":"23669-9998","pcpcounty":"","pcpid":"","pcpname":"Elizabeth Lakes Family Practice","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7578507315,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R10.2","F17.210","Q79.60","N94.10","R31.9","Z88.0","Z88.5","Z91.018","Z91.041","S99.911A","S99.921A","G57.01","M35.7","G57.00","M62.81","G89.4","Z51.81","M24.159","R42.","NO DATA","E89.40","M79.605","R10.32","R51.9","H93.19","Z11.59","I83.813","N94.89","I87.1","Z86.39","N94.6","J20.9","Z79.890","R09.81","M25.551","M25.552","M79.661","R10.9","R39.89","R53.83","R23.8","S70.262A","W57.XXXA","H66.91","J02.9","G89.29","R11.0","R07.81","R07.89","R06.02"],"date":["2021-12-09","2022-10-10","2022-05-24","2021-12-23","2021-12-09","2022-10-10","2022-10-10","2021-12-09","2021-12-09","2022-01-24","2022-01-24","2022-05-18","2022-05-18","2022-05-18","2022-05-18","2022-05-24","2022-05-24","2022-05-24","2022-07-14","2023-08-28","2022-11-01","2022-04-01","2022-04-01","2023-08-28","2023-08-28","2021-04-07","2021-10-15","2022-01-06","2022-01-06","2022-07-29","2022-07-29","2022-10-10","2022-10-10","2022-10-10","2022-01-27","2022-01-27","2022-07-14","2022-07-14","2022-07-14","2022-07-14","2022-10-06","2022-10-06","2022-10-06","2023-06-05","2023-06-05","2022-04-01","2022-04-01","2022-10-10","2022-10-10","2022-10-10"],"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":[["","68382005101","MELOXICAM","TAB 15MG","30","Select","Select",""],["","00555088602","ESTRADIOL","1 MG","45","Select","Select",""],["","65862090801","CELECOXIB","CAP 100MG","60","Select","Select",""],["","65862018601","CLINDAMYCIN","CAP 300MG","21","Select","Select",""],["","47682014513","ACETAMINOPHN","TAB 325MG","60","Select","Select",""],["","65162046550","IBUPROFEN","600 MG","21","Select","Select",""],["","72888001405","CYCLOBENZAPR","TAB 10MG","20","Select","Select",""],["","70010075401","METHOCARBAM","TAB 500MG","90","Select","Select",""],["","57664037708","TRAMADOL HCL","TAB 50MG","60","Select","Select",""],["","00093506101","HYDROXYZ HCL","TAB 25MG","30","Select","Select",""],["","70710116101","MECLIZINE","TAB 12.5MG","30","Select","Select",""],["","57896089601","VITAMIN B-12","TAB 1000MCG","30","Select","Select",""],["","42806040021","METHYLPRED","TAB 4MG","21","Select","Select",""],["","31722095801","BENZONATATE","CAP 200MG","21","Select","Select",""],["","11822365670","ACETAMIN","TAB 500MG","21","Select","Select",""],["","51672137001","MUPIROCIN","CRE 0.02","15","Select","Select",""],["","69238110005","DOXYCYCL HYC","CAP 100MG","20","Select","Select",""],["","68180096301","ALBUTEROL","AER HFA","8","Select","Select",""],["","00054001925","PREDNISONE","50 MG","5","Select","Select",""],["","27808008601","HYD POL\/CPM","SUS 10-8\/5ML","20","Select","Select",""],["","65862018601","CLINDAMYCIN HCL","300 MG","21","Select","Select",""],["","31722077701","ACYCLOVIR","400 MG","45","Select","Select",""],["","57237000511","FLUCONAZOLE","150 MG","2","Select","Select",""],["","31722070430","VALACYCLOVIR","500 MG","30","Select","Select",""],["","65162027210","SULFAMETHOXAZOLE-TRIMETHOPRIM","800-160 MG","14","Select","Select",""],["","11822300230","ACETAMINOPHEN","500 MG","20","Select","Select",""],["","29300041301","CYCLOBENZAPRINE HCL","5 MG","12","Select","Select",""],["","69238161503","OFLOXACIN","0.3 %","5","Select","Select",""],["","42806040021","METHYLPREDNISOLONE","4 MG","21","Select","Select",""],["","62332025118","AZITHROMYCIN","250 MG","6","Select","Select",""],["","00116200116","CHLORHEXIDINE GLUCONATE","0.12 %","473","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":""}]}]}