{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KATHY  M CRUZ-AMAYA","gend":1,"add":"4046 PROVIDENCE RD APT C","city":"HAYES","state":"VA","zip":"23072-9998","dob":"1968-06-12","age":"","mstatus":"","insh":"20026018*01","cliId":"","pno":7572270606,"cno":7572270606,"email":"","ename":"","eno":"","pphy":"NUSSEN, JANA MD","ppno":7578254273,"pcpadd":"2205 EXECUTIVE DRIVE SUITE D","pcpcity":"HAMPTON","pcpstate":"VA","pcpzip":"23666-9998","pcpcounty":"","pcpid":"","pcpname":"FAMILY PRACTICE OF HAMPTON ROADS","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7578254276,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N39.41","I10.","Z90.710","R39.81","G89.4","M47.816","M17.10","G89.29","F31.32","F90.1","F41.9","B20.","Z00.00","Z11.3","S70.01XA","M25.551","N30.00","V58.89","M54.2","R07.1","R51.9","R11.2","E11.9","Z21.","J44.9","E66.9","Z90.49","F17.210","Z79.899","S61.412A","Z79.84","R07.89","N89.8","R10.2","R10.9","A59.9","Z87.892","J45.909","K21.9","E66.01","Z88.5","Z88.1","G47.00","C54.1","S29.9XXA","Z48.02","R30.0","E27.8","N32.81","N39.46","Z13.220","M79.3","R07.9","K12.2","Z68.44","Z79.51","F17.200","R35.0","N39.0"],"date":["2022-01-14","2022-06-30","2022-01-14","2022-01-14","2021-03-22","2021-03-22","2021-03-22","2021-03-22","2023-04-11","2023-04-11","2023-04-11","2023-04-12","2022-01-24","2022-01-24","2022-04-21","2022-04-21","2022-11-09","2022-03-21","2022-06-30","2022-06-30","2022-06-30","2022-06-30","2022-06-30","2022-06-30","2022-06-30","2022-06-30","2022-06-30","2022-06-30","2022-06-30","2022-03-10","2022-04-21","2022-06-30","2021-09-07","2021-09-07","2021-09-07","2021-09-07","2021-09-07","2021-09-07","2021-09-07","2021-09-07","2021-09-07","2021-09-07","2022-08-04","2021-02-25","2021-09-27","2022-03-21","2021-06-08","2021-06-08","2021-06-08","2021-06-08","2021-08-06","2021-08-09","2022-07-01","2022-07-13","2022-04-21","2022-04-21","2023-04-12","2023-04-12","2023-04-12"],"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":[["","60505265501","TRAZODONE","TAB 150MG","30","Select","Select",""],["","45963055750","GABAPENTIN","400 MG","90","Select","Select",""],["","00378718505","METFORMIN","TAB 500MG","360","Select","Select",""],["","63304082805","ATORVASTATIN","TAB 20MG","90","Select","Select",""],["","00228203110","ALPRAZOLAM","1 MG","60","Select","Select",""],["","64980056210","FUROSEMIDE","20 MG","90","Select","Select",""],["","51672413304","LAMOTRIGINE","200 MG","60","Select","Select",""],["","70010077001","METHOCARBAM","TAB 750MG","30","Select","Select",""],["","00591352530","LIDOCAINE","PAD 0.05","30","Select","Select",""],["","68180098103","LISINOPRIL","20 MG","90","Select","Select",""],["","00406889401","AMPHET\/DEXTR","TAB 30MG","60","Select","Select",""],["","69097052444","DICLOFENAC","GEL 0.01","200","Select","Select",""],["","00406052201","OXYCOD\/APAP","TAB 7.5-325","90","Select","Select",""],["","61958250101","BIKTARVY","50-200-25","30","Select","Select",""],["","00185012201","NITROFURANTN","CAP 100MG","14","Select","Select",""],["","57237000630","FLUCONAZOLE","200 MG","12","Select","Select",""],["","53885099425","ONETOUCH","TES ULTRA","25","Select","Select",""],["","76204020025","ALBUTEROL","NEB 0.00083","75","Select","Select",""],["","42806054701","VITAMIN D","2 1250 MCG","4","Select","Select",""],["","00135046105","ALLI","60 MG","30","Select","Select",""],["","57844013001","ADDERALL","TAB 30MG","60","Select","Select",""],["","00378427677","VALACYCLOVIR","1000 MG","30","Select","Select",""],["","29300022701","METRONIDAZOL","TAB 500MG","14","Select","Select",""],["","63304061650","DOXYCYC MONO","CAP 100MG","20","Select","Select",""],["","68462019005","NAPROXEN","TAB 500MG","14","Select","Select",""],["","52817033010","CYCLOBENZAPR","TAB 5MG","30","Select","Select",""],["","00093598627","EPINEPHRINE","INJ 0.3MG","2","Select","Select",""],["","00093314505","CEPHALEXIN","CAP 250MG","20","Select","Select",""],["","59310057922","PROAIR HFA","90 MCG","8.5","Select","Select",""],["","00378113401","KETOROLAC","TAB 10MG","9","Select","Select",""],["","57237007710","ONDANSETRON","TAB 4MG ODT","12","Select","Select",""],["","65862018601","CLINDAMYCIN","CAP 300MG","40","Select","Select",""],["","43386048024","ORPHENADRINE","TAB 100MG ER","16","Select","Select",""],["","00406012305","HYDROCO\/APAP","TAB 5-325MG","15","Select","Select",""],["","75826011410","PHENAZOPYRID","TAB 100MG","6","Select","Select",""],["","65862017760","CEFDINIR","CAP 300MG","20","Select","Select",""],["","00002143380","TRULICITY","0.75MG\/0.5","2","Select","Select",""],["","69097014260","ALBUTEROL SULFATE HFA","90 MCG","6.7","Select","Select",""],["","13668033201","TRAZODONE HCL","150 MG","30","Select","Select",""],["","70010077001","METHOCARBAMOL","750 MG","30","Select","Select",""],["","43598083105","ATORVASTATIN CALCIUM","20 MG","90","Select","Select",""],["","00555097402","DEXTROAMPHETAMINE-AMPHETAMINE","30 MG","60","Select","Select",""],["","53885024450","ONETOUCH ULTRA TEST STRIP","","50","Select","Select",""],["","53885001110","ONETOUCH DELICA PLUS LANCET","30 GAUGE","100","Select","Select",""],["","67877056105","METFORMIN HCL","500 MG","360","Select","Select",""],["","53885014020","ONETOUCH SURESOFT","28 GAUGE","300","Select","Select",""],["","00115164501","NITROFURANTOIN","100 MG","14","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":""}]}]}