{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DEROD SESSOMS","gend":0,"add":"114 SUITE LIFE CIR APT A2","city":"NEWPORT NEWS","state":"VA","zip":"23606-9998","dob":"1976-10-15","age":"","mstatus":"","insh":"20034743*01","cliId":"","pno":7572476930,"cno":7572476930,"email":"","ename":"","eno":"","pphy":"SMITH, SAMANTHA I DO","ppno":7575944431,"pcpadd":"12420 WARWICK BOULEVARD BLDG 3 SUIT,","pcpcity":"NEWPORT NEWS","pcpstate":"VA","pcpzip":"23606-9998","pcpcounty":"","pcpid":"","pcpname":"Riverside Primary Care - Hidenwood","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7575942936,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["H93.8X2","D64.9","H69.82","I10.","E78.6","E78.1","E78.2","Z79.899","L70.0","L91.0","L53.8","R20.8","M79.605","R73.03","E66.9","Z68.32","F25.9","Z23.","F31.9","NO DATA","R51.9","Z20.822","R52.","Z77.120","Z79.1","Z88.0","Z88.8","F20.9","R20.2","E66.09","F17.210","L72.0","S46.211A","D50.9","S70.11XA","B37.49","R06.2","M25.552","G89.29","M79.89","F17.290","Z68.31"],"date":["2022-03-01","2022-04-21","2022-04-21","2023-09-13","2022-04-21","2022-04-21","2023-09-13","2022-08-08","2022-08-31","2022-08-31","2022-08-31","2022-08-31","2022-01-05","2023-09-13","2023-09-13","2021-06-08","2022-10-18","2022-03-16","2022-08-08","2022-08-08","2022-08-08","2022-12-29","2022-08-08","2022-08-08","2022-08-08","2022-08-08","2022-08-08","2021-01-27","2021-01-27","2021-01-27","2021-01-27","2022-08-31","2022-10-26","2022-01-05","2022-06-30","2022-08-24","2022-08-24","2022-08-24","2022-08-24","2022-06-30","2023-09-13","2023-09-13"],"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":[["","45963067711","METOPROL SUC TAB","100MG ER","90","Select","Select",""],["","13668048450","MINOCYCLINE CAP","100MG","60","Select","Select",""],["","11917018001","ARTHRTS PAIN TAB","650MG","60","Select","Select",""],["","64380080807","IBUPROFEN TAB","600MG","60","Select","Select",""],["","55111012405","ATORVASTATIN TAB","80MG","45","Select","Select",""],["","00904759080","FEROSUL TAB","325MG","30","Select","Select",""],["","67877024801","QUETIAPINE TAB","400MG","30","Select","Select",""],["","68462048627","CLINDAMY\/BEN GEL","1-5%","50","Select","Select",""],["","65162003416","OMEGA-","3 ACID ETHYL ESTERS 1 G","360","Select","Select",""],["","11822880250","RA VITAMIN C TAB","250MG","90","Select","Select",""],["","00378306577","FENOFIBRATE TAB","48MG","90","Select","Select",""],["","68682001004","SULFACETAMID LOT","10%","236","Select","Select",""],["","69097082707","BENZTROPINE TAB","1MG","30","Select","Select",""],["","11822619080","ALLERGY\/CONG TAB","5-120MG","20","Select","Select",""],["","11523716202","CLARITIN-D TAB","5-120MG","20","Select","Select",""],["","60505082901","FLUTICASONE SPR","50MCG","16","Select","Select",""],["","11845012232","FISH OIL CAP","1000MG","120","Select","Select",""],["","00378808245","TRETINOIN CRE","0.025%","45","Select","Select",""],["","68462019005","NAPROXEN TAB","500MG","20","Select","Select",""],["","11917009215","FERROUS SULF TAB","325MG","30","Select","Select",""],["","00574200830","NYSTOP POW","100000","30","Select","Select",""],["","57237002801","AMOXICILLIN TAB","500MG","21","Select","Select",""],["","00093317431","ALBUTEROL AER HFA","","8","Select","Select",""],["","65162083366","DICLOFENAC GEL","1%","100","Select","Select",""],["","69315030630","NYSTATIN POW","100000","30","Select","Select",""],["","60505082901","FLUTICASONE PROPIONATE","50 MCG","16","Select","Select",""],["","69097082607","BENZTROPINE MESYLATE","0.5 MG","30","Select","Select",""],["","00904759080","FEROSUL","325(65) MG","30","Select","Select",""],["","69097052444","DICLOFENAC SODIUM","1 %","100","Select","Select",""],["","16729015001","QUETIAPINE FUMARATE","400 MG","30","Select","Select",""],["","56362000589","IHEALTH COVID-","19 AG HOME TEST","8","Select","Select",""],["","00591569550","MINOCYCLINE HCL","100 MG","60","Select","Select",""],["","43598083305","ATORVASTATIN CALCIUM","80 MG","90","Select","Select",""],["","45963067711","METOPROLOL SUCCINATE","100 MG","90","Select","Select",""],["","65862076890","FENOFIBRATE","48 MG","90","Select","Select",""],["","82607066026","FLOWFLEX COVID-","19 AG HOME TEST","8","Select","Select",""],["","46122006271","8HR PAIN REL","TAB 650MG","60","Select","Select",""],["","65862021150","MINOCYCLINE","CAP 100MG","60","Select","Select",""],["","45963067711","METOPROL SUC","TAB 100MG ER","90","Select","Select",""],["","55111012405","ATORVASTATIN","TAB 80MG","45","Select","Select",""],["","51660033301","ARTHRTS PAIN","TAB 650MG","60","Select","Select",""],["","67877024810","QUETIAPINE","TAB 400MG","30","Select","Select",""],["","64380080707","IBUPROFEN","TAB 800MG","20","Select","Select",""],["","68462048627","CLINDAMY\/BEN","GEL 1-5%","100","Select","Select",""],["","11822880250","RA VITAMIN C","TAB 250MG","90","Select","Select",""],["","65162003416","OMEGA-3-ACID","CAP 1GM","120","Select","Select",""],["","68682001004","SULFACETAMID","LOT 0.1","236","Select","Select",""],["","69097082707","BENZTROPINE","TAB 1MG","30","Select","Select",""],["","11523716202","CLARITIN-D","TAB 5-120MG","20","Select","Select",""],["","11822040192","8 HOUR PAIN","TAB 650MG","60","Select","Select",""],["","11822619080","ALLERGY\/CONG","TAB 5-120MG","20","Select","Select",""],["","00378808245","TRETINOIN","CRE 0.00025","45","Select","Select",""],["","68462019005","NAPROXEN","TAB 500MG","20","Select","Select",""],["","60505082901","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","11917009215","FERROUS SULF","TAB 325MG","30","Select","Select",""],["","57237002801","AMOXICILLIN","TAB 500MG","21","Select","Select",""],["","68180096301","ALBUTEROL","AER HFA","8","Select","Select",""],["","11845012232","FISH OIL","CAP 1000MG","120","Select","Select",""],["","00574200830","NYSTOP","POW 100000","30","Select","Select",""],["","69315030630","NYSTATIN","POW 100000","30","Select","Select",""],["","65162083366","DICLOFENAC","GEL 0.01","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":""}]}]}