{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CHRISTINA WAFF","gend":1,"add":"2415 LAFAYETTE BLVD","city":"NORFOLK","state":"VA","zip":"23509-9998","dob":"1981-05-10","age":"","mstatus":"","insh":"1714227*01","cliId":"","pno":7572272369,"cno":7572272369,"email":"","ename":"","eno":"","pphy":"TAYLOR, ALEX MD","ppno":7576230095,"pcpadd":"SUITE 1 1401 TIDEWATER AVE","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":"23504-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7576231203,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["S59.901A","M25.521","B20.","I10.","E11.9","V62.84","F14.10","J20.9","R07.89","Z20.822","G47.10","G47.33","G47.61","F25.1","R56.9","Z53.21","Z79.899","J06.9","Z59.00","R06.02","R52.","S80.12XA","M25.472","J44.9","F17.210","Z21.","M79.605","J11.1","R50.9","R53.83","R07.0","B37.2","N89.8","N92.0","F17.200","S99.912A","M79.621","M25.552","M79.652","M79.672","M79.662","R26.89","NO DATA","R06.89","B34.9","E86.0","Z76.0","S99.911A","G47.50","B97.89","T50.916A","Z91.14","R07.9","J02.9","Z23.","E16.2","R10.9","R41.82","F15.90","T14.90XA","E11.649","T38.3X5A","E11.43","K31.84","Z79.4","R41.0","R10.84","R11.2","F10.129","F19.10","R00.0"],"date":["2022-12-09","2022-12-09","2023-04-17","2023-01-25","2023-04-12","2023-02-14","2023-04-14","2023-02-10","2022-09-28","2023-02-22","2022-10-03","2023-04-14","2022-10-03","2023-04-22","2023-03-17","2023-03-17","2023-03-17","2023-02-22","2023-02-09","2023-02-09","2023-02-10","2023-01-13","2023-01-13","2023-02-09","2023-04-14","2023-04-14","2023-01-13","2023-02-09","2023-02-22","2023-02-22","2022-09-28","2022-11-04","2022-11-04","2022-11-04","2022-11-04","2022-12-09","2022-12-09","2022-12-09","2022-12-09","2022-12-09","2022-12-09","2022-12-09","2023-04-20","2023-01-11","2023-02-09","2023-02-09","2023-02-09","2022-12-09","2022-10-27","2023-01-11","2023-01-11","2023-01-11","2023-01-11","2023-02-22","2022-10-26","2023-04-06","2023-04-12","2023-04-14","2023-04-20","2022-12-09","2023-04-09","2023-04-09","2023-04-09","2023-04-14","2023-04-09","2023-04-09","2023-04-12","2023-04-12","2023-04-14","2023-04-17","2023-04-17"],"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":[["","00603533832","PREDNISONE","TAB 10MG","16","Select","Select",""],["","42192060716","BROM\/PSE\/DM","SYP 2\/30\/10","300","Select","Select",""],["","42806071405","BENZONATATE","100 MG","30","Select","Select",""],["","68462015713","ONDANSETRON","TAB 4MG ODT","12","Select","Select",""],["","45802086802","POLYETH GLYC","POW 3350 NF","238","Select","Select",""],["","51224000760","METFORMIN","TAB 500MG ER","30","Select","Select",""],["","60505024708","MIRTAZAPINE","15 MG","30","Select","Select",""],["","68382014014","TOPIRAMATE","100 MG","60","Select","Select",""],["","55111014512","FLUCONAZOLE","TAB 150MG","3","Select","Select",""],["","00378110101","PRAZOSIN HCL","1 MG","30","Select","Select",""],["","00378117591","BUSPIRONE","TAB 30MG","60","Select","Select",""],["","57896020110","PAIN RELIEF","500 MG","60","Select","Select",""],["","16714049601","CLOTRIM\/BETA","CRE 1-0.05%","90","Select","Select",""],["","65162046550","IBUPROFEN","600 MG","60","Select","Select",""],["","42571016242","AMOXICILLIN-CLAVULANATE POTASS","875-125 MG","20","Select","Select",""],["","51224000760","METFORMIN HCL ER","500 MG","30","Select","Select",""],["","00093005401","BUSPIRONE HCL","10 MG","90","Select","Select",""],["","68180011416","LEVETIRACETAM","750 MG","30","Select","Select",""],["","68462015713","ONDANSETRON ODT","4 MG","12","Select","Select",""],["","75834022100","CARBAMAZEPINE","200 MG","30","Select","Select",""],["","68180098003","LISINOPRIL","10 MG","30","Select","Select",""],["","50111078710","AZITHROMYCIN","250 MG","6","Select","Select",""],["","65862052890","VENLAFAXINE HCL ER","75 MG","30","Select","Select",""],["","49702024613","DOVATO","50MG-300MG","30","Select","Select",""],["","10702000310","PROMETHAZINE HCL","25 MG","30","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":""}]}]}