{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MAKIYHIA BAYLOR","gend":1,"add":"202 BLOUNT CT","city":"HAMPTON","state":"VA","zip":"23663-9998","dob":"2003-07-03","age":"","mstatus":"","insh":"1500380*01","cliId":"","pno":7576025205,"cno":7576025205,"email":"","ename":"","eno":"","pphy":"HOLTZ, KRISTEN E DO","ppno":7578271940,"pcpadd":"3401 W MERCURY BLVD,","pcpcity":"HAMPTON","pcpstate":"VA","pcpzip":"23666-9998","pcpcounty":"","pcpid":"","pcpname":"Riverside Primary Care Mercury West","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7575964715,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R11.2","R10.84","F12.188","E86.0","E87.6","R10.11","N30.00","Z88.8","R63.8","H92.02","T78.40XA","R30.0","F12.90","J40.","J06.9","B96.89","K90.0","Z79.899","F17.290","Z88.6","Z53.21","R10.9","Z87.891","R11.14","R10.31","R11.10","R06.02","K29.70","E16.2","F12.10","R10.2","V58.69","Z91.128","N30.01","R10.13","N17.9","K29.00","F12.988","NO DATA","K92.2","R11.0","R10.32","K59.00","N39.0","F41.0","K21.9","D72.829"],"date":["2023-01-12","2023-01-03","2023-01-02","2023-01-03","2023-01-06","2023-01-12","2023-01-12","2023-01-12","2023-01-12","2023-02-21","2023-02-21","2022-09-17","2023-01-01","2022-10-07","2022-10-07","2022-10-07","2022-06-05","2023-01-06","2023-09-14","2022-09-16","2022-09-16","2023-01-02","2023-01-02","2022-09-13","2022-09-13","2023-09-14","2023-01-03","2022-06-02","2022-06-02","2022-06-02","2022-12-29","2022-12-29","2022-12-29","2023-01-01","2023-01-06","2022-01-31","2022-09-14","2022-09-14","2023-09-12","2022-06-05","2022-09-13","2022-09-13","2023-05-05","2023-09-14","2023-08-01","2023-09-12","2023-09-12"],"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":[["","65862039010","ONDANSETRON","TAB 4MG ODT","12","Select","Select",""],["","70710113908","FLUCONAZOLE","150 MG","1","Select","Select",""],["","51862025801","NEXTSTELLIS","TAB 3-14.2MG","84","Select","Select",""],["","29033000305","SUCRALFATE","TAB 1GM","90","Select","Select",""],["","00143122701","DICYCLOMINE","TAB 20MG","30","Select","Select",""],["","51672401801","ETODOLAC","TAB 400MG","30","Select","Select",""],["","57237016199","OMEPRAZOLE","20 MG","90","Select","Select",""],["","65162074510","PROMETHAZINE","TAB 12.5MG","20","Select","Select",""],["","16714044601","AMITRIPTYLIN","TAB 10MG","30","Select","Select",""],["","00781808926","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","00591544210","PREDNISONE","TAB 10MG","10","Select","Select",""],["","00574110404","BROM\/PSE\/DM","SYP ","120","Select","Select",""],["","37000045503","PRILOSEC OTC","TAB 20MG","28","Select","Select",""],["","65862039010","ONDANSETRON ODT","4 MG","8","Select","Select",""],["","00832151011","HALOPERIDOL","0.5 MG","12","Select","Select",""],["","16714043901","NITROFURANTOIN MONO-MACRO","100 MG","14","Select","Select",""],["","00904530660","BANOPHEN","25 MG","24","Select","Select",""],["","65862098799","POTASSIUM CHLORIDE","10 MEQ","10","Select","Select",""],["","00378334053","XULANE","150-35\/24H","3","Select","Select",""],["","59779030601","PURELAX","17 G\/DOSE","119","Select","Select",""],["","65862039010","ONDANSETRON TAB","4MG ODT","12","Select","Select",""],["","51862025801","NEXTSTELLIS TAB","3-14.2MG","84","Select","Select",""],["","57237000511","FLUCONAZOLE TAB","150MG","1","Select","Select",""],["","45802075930","PROMETHAZINE SUP","25MG","10","Select","Select",""],["","51672401801","ETODOLAC TAB","400MG","30","Select","Select",""],["","65162074510","PROMETHAZINE TAB","12.5MG","20","Select","Select",""],["","00143122701","DICYCLOMINE TAB","20MG","30","Select","Select",""],["","29033000305","SUCRALFATE TAB","1GM","90","Select","Select",""],["","16714044601","AMITRIPTYLIN TAB","10MG","30","Select","Select",""],["","00536132271","OMEPRAZOLE TAB","20MG DR","28","Select","Select",""],["","37000045503","PRILOSEC OTC TAB","20MG","28","Select","Select",""],["","16714071503","OMEPRAZOLE CAP","20MG","30","Select","Select",""],["","00574110404","BROM\/PSE\/DM SYP","","120","Select","Select",""],["","00781808926","AZITHROMYCIN TAB","250MG","6","Select","Select",""],["","00591544210","PREDNISONE TAB","10MG","10","Select","Select",""],["","13668013601","ESCITALOPRAM OXALATE","10 MG","90","Select","Select",""],["","42806015905","HYDROXYZINE HCL","10 MG","30","Select","Select",""],["","53746074501","PROMETHAZINE HCL","12.5 MG","15","Select","Select",""],["","51672128902","NYSTATIN","100000\/G","30","Select","Select",""],["","68180012202","CEPHALEXIN","500 MG","28","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":""}]}]}