{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TAE'SEAN CRUTCHFIELD","gend":0,"add":"158 YEARDLEY DR APT 6","city":"NEWPORT NEWS","state":"VA","zip":"23601-9998","dob":"2001-01-27","age":"","mstatus":"","insh":"1678446*01","cliId":"","pno":8044893713,"cno":8044893713,"email":"","ename":"","eno":"","pphy":"NYIRENDA, FAFA I MD","ppno":8048649600,"pcpadd":"4744 FINLAY ST,","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":"23231-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":8048649647,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F33.1","S31.139A","K65.9","S31.109A","G89.18","G89.11","R10.9","Z48.01","K63.2","Z94.5","E43.","I82.B11","J93.9","Z68.1","F32.9","F43.23","I10.","L89.159","G47.9","Z53.29","Z20.822","Z87.828","R94.31","G89.21","E86.0","I82.729","NO DATA","I82.B12","R52.","V58.89","R10.31","R11.2","J18.9","J10.1","Z90.49","Z93.3","F17.200","F31.81","F33.2","S21.239A","T81.83XA","I82.621","K56.7","K94.13","I82.612","E83.42","E87.6","F43.21","F43.10","W34.00XA","K31.6","Z46.82","Z46.59","S31.609A","Z48.815","Z48.298","F41.9","F90.9","Z79.891","Z93.1","Z93.4","Z87.891","Z91.81","F33.3","E46.","I95.89","E86.1","I82.722","G89.29","K43.9","W34.00XD","F32.2","F41.1","I82.B19","Z98.890","R51.9","Z53.21","S36.400A","R00.0","I82.C12","I82.622","I82.A12","I82.712","L89.152","R26.9","I49.9","E44.0","S36.498A","T79.4XXA","K66.1","J96.01","A41.9","K75.0","D62.","N17.9","E87.1","E78.1","Z99.11","Y24.9XXA","V24.9XXA","Z97.8","D72.829","I82.721","K43.2","K66.0","K91.89","Z86.718","R60.9","F32.0","F32.3"],"date":["2023-09-11","2022-01-29","2021-07-08","2021-11-05","2022-02-01","2021-08-31","2022-10-19","2022-02-16","2022-05-19","2021-08-16","2022-02-16","2021-09-29","2021-09-29","2021-11-06","2023-02-25","2022-02-03","2021-09-29","2021-09-29","2021-09-29","2021-11-06","2022-10-19","2021-10-24","2021-10-09","2022-01-27","2022-01-25","2022-02-16","2022-01-25","2022-01-18","2022-06-07","2022-02-02","2022-10-19","2022-10-19","2022-10-19","2022-10-19","2022-10-19","2022-10-19","2022-10-19","2023-03-08","2023-05-07","2021-06-29","2021-08-07","2021-08-07","2021-08-07","2021-08-07","2021-08-07","2021-08-08","2021-08-07","2021-08-30","2021-08-07","2021-08-07","2021-08-09","2021-08-09","2021-08-10","2021-08-11","2022-02-16","2022-02-16","2022-02-16","2022-02-16","2022-02-16","2022-02-16","2022-02-16","2022-02-16","2022-02-16","2023-03-03","2021-07-24","2021-10-24","2021-10-24","2022-01-24","2022-01-25","2022-01-25","2022-01-25","2023-03-21","2023-03-31","2021-08-23","2021-08-24","2022-07-12","2022-07-12","2021-07-11","2022-01-29","2022-01-17","2022-01-17","2022-01-17","2022-01-17","2022-01-17","2022-02-05","2021-10-04","2021-10-24","2021-06-27","2021-06-27","2021-06-27","2021-06-27","2021-06-27","2021-06-27","2021-11-06","2021-06-27","2021-06-27","2021-06-27","2021-06-27","2021-06-27","2021-06-27","2021-06-27","2021-11-06","2022-01-06","2022-01-25","2022-01-25","2022-01-25","2022-01-01","2022-06-07","2023-08-28","2023-07-29"],"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":[["","00904667840","OXYCODONE","SOL 5MG\/5ML","350","Select","Select",""],["","65862056099","PANTOPRAZOLE","TAB 40MG","60","Select","Select",""],["","49483008010","SENNA-TIME","TAB 8.6MG","30","Select","Select",""],["","00003089421","ELIQUIS","TAB 5MG","60","Select","Select",""],["","68462010530","ONDANSETRON","TAB 4MG","20","Select","Select",""],["","42806031250","DOXYCYCL HYC","TAB 100MG","10","Select","Select",""],["","00781185220","AMOX\/K CLAV","TAB 875-125","10","Select","Select",""],["","70010077001","METHOCARBAM","TAB 750MG","21","Select","Select",""],["","64380080807","IBUPROFEN","600 MG","30","Select","Select",""],["","13107003134","MIRTAZAPINE","15 MG","30","Select","Select",""],["","65862001205","SERTRALINE HCL","50 MG","30","Select","Select",""],["","68180031909","BUPROPION XL","150 MG","30","Select","Select",""],["","00904667840","OXYCODONE SOL","5MG\/5ML","350","Select","Select",""],["","65862056099","PANTOPRAZOLE TAB","40MG","60","Select","Select",""],["","49483008010","SENNA-TIME TAB","8.6MG","30","Select","Select",""],["","00003089421","ELIQUIS TAB","5MG","60","Select","Select",""],["","00781185220","AMOX\/K CLAV TAB","875-125","10","Select","Select",""],["","68462010530","ONDANSETRON TAB","4MG","20","Select","Select",""],["","42806031250","DOXYCYCL HYC TAB","100MG","10","Select","Select",""],["","70010077001","METHOCARBAM TAB","750MG","21","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":""}]}]}