{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ASHLEIGH  C OWENS","gend":1,"add":"4602 HAZELWOOD ROAD","city":"HAMPTON","state":"VA","zip":"23666-9998","dob":"1990-08-24","age":"","mstatus":"","insh":"1835547*01","cliId":"","pno":7577514849,"cno":7577514849,"email":"","ename":"","eno":"","pphy":"WEBSTER, ELIZABETH MD","ppno":7579755200,"pcpadd":"7401 WARWICK BLVD","pcpcity":"NEWPORT NEWS","pcpstate":"VA","pcpzip":"23607-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7572230829,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E28.2","E66.01","L68.0","E55.9","Z68.42","S61.012A","Z21.","F90.0","N20.0","N30.01","L73.2","Z23.","J34.89","N23.","N39.0","R34.","R60.0","J20.9","N76.2","K04.7","K02.9","J01.00","R73.9","R03.0","F17.210","E66.9","F33.1","Z13.31","Z20.828","B37.3","Z01.419","Z12.4","Z11.3","Z20.822"],"date":["2021-01-08","2021-01-08","2021-01-08","2022-08-01","2022-08-29","2021-12-31","2023-03-06","2023-03-06","2022-11-14","2021-11-20","2022-08-29","2022-08-29","2022-10-20","2022-11-11","2022-11-11","2022-11-11","2021-04-29","2021-06-01","2021-08-14","2022-10-09","2022-10-13","2022-10-13","2022-10-13","2022-10-13","2022-10-13","2022-10-13","2023-01-11","2023-03-06","2022-04-05","2022-04-05","2023-03-06","2023-03-06","2023-03-06","2021-12-31"],"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":[["","00527150537","AMPHET\/DEXTR","TAB 20MG","60","Select","Select",""],["","57844012001","ADDERALL","TAB 20MG","90","Select","Select",""],["","13107006101","PHENTERMINE","TAB 37.5MG","90","Select","Select",""],["","00378020810","FUROSEMIDE","TAB 20MG","3","Select","Select",""],["","59746000103","METHYLPRED","TAB 4MG","21","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","8","Select","Select",""],["","70710113908","FLUCONAZOLE","TAB 150MG","2","Select","Select",""],["","72578008804","NYSTAT\/TRIAM","OIN ","30","Select","Select",""],["","67877021560","CEFUROXIME","TAB 250MG","20","Select","Select",""],["","11822059042","MUCUS RELIEF","TAB 60-600MG","2","Select","Select",""],["","59310057922","PROAIR HFA","AER ","8","Select","Select",""],["","42192080201","PHENAZOPYRID","TAB 200MG","9","Select","Select",""],["","00185012201","NITROFURANTN","CAP 100MG","10","Select","Select",""],["","61958250101","BIKTARVY","TAB ","30","Select","Select",""],["","65862064169","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","69452015120","VITAMIN D","CAP 50000UNT","12","Select","Select",""],["","49702024015","CABENUVA","600-900\/3","6","Select","Select",""],["","47335070786","TOPIRAMATE","TAB 25MG","60","Select","Select",""],["","57664037708","TRAMADOL HCL","TAB 50MG","9","Select","Select",""],["","65862050320","AMOX\/K CLAV","TAB 875-125","20","Select","Select",""],["","65862059801","TAMSULOSIN","CAP 0.4MG","30","Select","Select",""],["","65162089129","MOMETASONE","SPR 50MCG","17","Select","Select",""],["","00093031401","KETOROLAC","TAB 10MG","20","Select","Select",""],["","65862037405","ESCITALOPRAM","TAB 10MG","30","Select","Select",""],["","65862039010","ONDANSETRON","TAB 4MG ODT","20","Select","Select",""],["","65862007701","CIPROFLOXACN","TAB 500MG","20","Select","Select",""],["","00603548321","PROPRANOLOL HCL","20 MG","90","Select","Select",""],["","00115180401","HYDROXYZINE PAMOATE","50 MG","60","Select","Select",""],["","16571066401","METRONIDAZOLE","500 MG","14","Select","Select",""],["","11527075043","SODIUM FLUORIDE","1.1 %","100","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":""}]}]}