{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CHEYENNE KLUTTS","gend":1,"add":"27529 BLUEBERRY DR","city":"CAPE CHARLES","state":"VA","zip":"23310-9998","dob":"1992-01-05","age":"","mstatus":"","insh":"1526615*01","cliId":"","pno":7576076195,"cno":7576076195,"email":"","ename":"","eno":"","pphy":"JOYNER, LINWOOD MD","ppno":7574426600,"pcpadd":"10085 WILLIAM F BERNART CIRCLE","pcpcity":"NASSAWADOX","pcpstate":"VA","pcpzip":"23413-9998","pcpcounty":"","pcpid":"","pcpname":"Riverside Eastern Shore Family Medicine","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7574423839,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R07.89","F17.210","N18.1","R07.9","Z20.828","R11.10","R19.7","R05.","Z00.00","E66.09","Z68.39","F31.9","F33.1","F41.1","R05.9","R06.2","R09.81","R53.83","O23.41","B96.89","Z3A.01","V23.87","O99.891","R10.9","M25.522","M25.512","M75.41","M77.11","J01.11","J30.9","Z68.38","J45.40","L02.413","F41.0","E72.12","M79.603","R10.2","N94.6","K58.2","G89.29","E86.0","Z23.","K52.9","R10.32","R19.4","R11.2","R93.3","R93.89","N92.0","Z30.09","Z98.891","J01.01","Z20.822","J02.9","R51.9","Z71.89","N28.1","K80.20","U07.1","N28.9","R31.29","N39.41","N32.81","N20.1"],"date":["2022-05-12","2023-02-20","2022-05-12","2022-05-12","2022-01-13","2021-02-22","2021-02-22","2021-02-22","2022-04-12","2023-01-13","2022-04-12","2023-01-13","2023-01-13","2023-01-13","2023-02-20","2022-05-09","2022-05-09","2022-05-09","2021-02-05","2021-02-05","2021-02-15","2021-02-15","2021-02-15","2021-02-15","2021-10-18","2021-10-18","2021-10-27","2021-10-27","2021-11-22","2021-11-22","2023-01-13","2023-01-13","2021-04-12","2021-04-05","2021-04-05","2021-10-18","2022-12-05","2023-01-03","2023-01-03","2022-12-05","2023-01-26","2022-09-08","2023-02-20","2023-02-22","2023-02-22","2023-02-22","2023-02-22","2022-09-26","2023-01-03","2023-01-03","2023-01-03","2021-12-10","2021-12-10","2022-01-13","2022-01-13","2022-01-13","2023-03-13","2023-02-20","2022-07-14","2023-03-13","2023-03-30","2023-03-13","2023-03-13","2023-03-30"],"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":[["","67877021905","CEPHALEXIN","CAP 500MG","40","Select","Select",""],["","68382004001","PROMETHAZINE","TAB 12.5MG","10","Select","Select",""],["","00406052201","OXYCOD\/APAP","TAB 7.5-325","8","Select","Select",""],["","57237023305","SMZ-TMP DS","TAB 800-160","14","Select","Select",""],["","59762372004","ALPRAZOLAM","TAB 0.5MG","60","Select","Select",""],["","65862042005","SMZ\/TMP DS","TAB 800-160","14","Select","Select",""],["","51991008490","FOLBEE","TAB ","30","Select","Select",""],["","10702002601","PHENTERMINE","CAP 15MG","30","Select","Select",""],["","69097012403","TOPIRAMATE","100 MG","30","Select","Select",""],["","65862052730","VENLAFAXINE","CAP 37.5 ER","30","Select","Select",""],["","00069047103","CHANTIX","PAK 0.5& 1MG","53","Select","Select",""],["","16729016917","ESCITALOPRAM","TAB 10MG","30","Select","Select",""],["","62011017101","HM NICOTINE","LOZ 4MG MINT","72","Select","Select",""],["","59310057922","PROAIR HFA","AER ","8","Select","Select",""],["","65162035803","ZAFEMY","DIS 150\/35","3","Select","Select",""],["","60505082901","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","16714079904","CETIRIZINE","TAB 10MG","30","Select","Select",""],["","65862050320","AMOX\/K CLAV","TAB 875-125","28","Select","Select",""],["","16714069211","FLUCONAZOLE","150 MG","2","Select","Select",""],["","51293084505","IBUPROFEN","800 MG","21","Select","Select",""],["","68180096301","ALBUTEROL","AER HFA","8","Select","Select",""],["","00173071920","FLOVENT HFA","AER 110MCG","12","Select","Select",""],["","00173068220","VENTOLIN HFA","AER ","18","Select","Select",""],["","00527293441","PREDNISONE","TAB 20MG","21","Select","Select",""],["","49884015676","VARENICLINE","TAB 1MG","56","Select","Select",""],["","00069108530","PAXLOVID","TAB 300-100","30","Select","Select",""],["","82607066026","FLOWFLEX","KIT TEST","2","Select","Select",""],["","51672413001","LAMOTRIGINE","TAB 25MG","30","Select","Select",""],["","00378334053","XULANE","DIS 150-35","3","Select","Select",""],["","43547028111","ESCITALOPRAM OXALATE","10 MG","30","Select","Select",""],["","10702002601","PHENTERMINE HCL","15 MG","30","Select","Select",""],["","57237007730","ONDANSETRON ODT","4 MG","12","Select","Select",""],["","65862052730","VENLAFAXINE HCL ER","37.5 MG","30","Select","Select",""],["","82607066026","FLOWFLEX COVID-","19 AG HOME TEST","4","Select","Select",""],["","00116200116","CHLORHEXIDINE GLUCONATE","0.12 %","473","Select","Select",""],["","68382004110","PROMETHAZINE HCL","25 MG","60","Select","Select",""],["","57237003105","AMOXICILLIN","500 MG","30","Select","Select",""],["","65862050320","AMOXICILLIN-CLAVULANATE POTASS","875-125 MG","20","Select","Select",""],["","65862007701","CIPROFLOXACIN HCL","500 MG","20","Select","Select",""],["","43386006019","GAVILYTE-C","240-22.72G","4000","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":""}]}]}