{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ALISSA N WEAVER","gend":1,"add":"1161 NANSEMOND PKWY LOT 78","city":"SUFFOLK","state":"VA","zip":"23434-9998","dob":"1981-07-13","age":"","mstatus":"","insh":"20053951*01","cliId":"","pno":7578090300,"cno":7578090300,"email":"","ename":"","eno":"","pphy":"NGWA, BENEDICT NP","ppno":7574831700,"pcpadd":"4868 BRIDGE RD STE 300,","pcpcity":"SUFFOLK","pcpstate":"VA","pcpzip":"23435-9998","pcpcounty":"","pcpid":"","pcpname":"Lakeview Pediatrics & Family Medicine","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7574837150,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F31.4","F60.3","R10.9","R19.4","K21.9","F17.200","Z68.41","N94.89","E66.01","K64.2","U07.1","N83.201","N83.202","N91.1","M54.5","M43.8X6","K64.4","K64.8","K13.0","E53.8","E78.5","Z11.3","I10.","R53.83","E55.9","M54.9","G89.29","NO DATA","R10.2","M54.2","M25.512","F17.209","K27.9","J45.909","Z01.419","F31.81","F90.0","F43.12","G47.00","N95.0","R10.12","R10.30","R10.13","R10.11","K29.70","K90.89","Z86.010","E07.9","R63.5","K76.0","N85.8","Z90.49","J01.90","R35.0","R14.0","R11.2","K31.89","K26.9","R11.0","K57.30","K63.5","Z20.828","Z20.822","J45.901","S92.355A","M79.672","R19.7","Z68.39","R82.90"],"date":["2023-09-16","2023-09-16","2023-02-21","2021-04-29","2023-01-03","2021-02-22","2021-02-22","2021-11-02","2021-11-02","2022-05-17","2022-01-14","2023-05-09","2023-05-09","2021-01-29","2021-05-14","2021-05-14","2022-03-25","2022-03-25","2022-05-19","2022-05-19","2022-05-19","2022-05-19","2022-05-19","2022-05-19","2022-05-19","2022-05-19","2022-06-24","2022-06-24","2023-05-09","2021-04-20","2021-04-20","2021-08-11","2021-08-11","2021-08-11","2022-02-22","2023-07-26","2023-07-26","2023-07-26","2023-07-26","2023-09-12","2023-02-07","2023-01-03","2023-01-03","2023-02-21","2021-10-14","2023-02-21","2021-10-14","2022-02-24","2022-02-24","2023-02-21","2023-02-07","2023-02-07","2023-03-02","2023-03-02","2021-04-29","2021-04-29","2021-04-29","2021-04-29","2021-04-29","2021-04-29","2021-04-29","2021-09-17","2022-01-17","2023-01-17","2022-01-04","2022-01-04","2023-02-21","2023-02-21","2023-09-12"],"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":[["","23601009760","ALUM CRUTCH","MIS ADULT PB","2","Select","Select",""],["","00093506001","HYDROXYZ HCL","TAB 10MG","30","Select","Select",""],["","29300014901","QUETIAPINE","TAB 100MG","30","Select","Select",""],["","31722016930","DULOXETINE","CAP 30MG","30","Select","Select",""],["","29300046805","CLONIDINE","TAB 0.1MG","60","Select","Select",""],["","59310057922","PROAIR HFA","AER ","8","Select","Select",""],["","00406051201","OXYCOD\/APAP","TAB 5-325MG","25","Select","Select",""],["","49483060450","IBUPROFEN","TAB 800MG","30","Select","Select",""],["","29300022019","MONTELUKAST","TAB 10MG","30","Select","Select",""],["","62559015710","POLYETH GLYC","POW 3350 NF","20","Select","Select",""],["","68180096301","ALBUTEROL","AER HFA","8","Select","Select",""],["","17478071130","LIDOCAINE","GEL 2% JELLY","30","Select","Select",""],["","00093101042","MUPIROCIN","OIN 0.02","22","Select","Select",""],["","68462043730","OLMESA MEDOX","TAB 20MG","90","Select","Select",""],["","42806054701","VITAMIN D","2 1250 MCG","12","Select","Select",""],["","57237000511","FLUCONAZOLE","150 MG","1","Select","Select",""],["","69097012303","TOPIRAMATE","50 MG","30","Select","Select",""],["","55111064505","OMEPRAZOLE","40 MG","60","Select","Select",""],["","82607066026","FLOWFLEX","KIT TEST","4","Select","Select",""],["","31722071530","ATOMOXETINE","CAP 18MG","30","Select","Select",""],["","50228018001","GABAPENTIN","300 MG","30","Select","Select",""],["","63304061650","DOXYCYCLINE MONOHYDRATE","100 MG","28","Select","Select",""],["","16571080901","QUETIAPINE FUMARATE","150 MG","30","Select","Select",""],["","29300022019","MONTELUKAST SODIUM","10 MG","30","Select","Select",""],["","68462043730","OLMESARTAN MEDOXOMIL","20 MG","90","Select","Select",""],["","31722071390","PANTOPRAZOLE SODIUM","40 MG","30","Select","Select",""],["","00143924920","AMOXICILLIN-CLAVULANATE POTASS","875-125 MG","20","Select","Select",""],["","31722016930","DULOXETINE HCL","30 MG","30","Select","Select",""],["","16571066401","METRONIDAZOLE","500 MG","14","Select","Select",""],["","66993001968","ALBUTEROL SULFATE HFA","90 MCG","18","Select","Select",""],["","50111078810","AZITHROMYCIN","500 MG","5","Select","Select",""],["","42806040021","METHYLPREDNISOLONE","4 MG","21","Select","Select",""],["","59762045001","COLESTIPOL HCL","1 G","60","Select","Select",""],["","00093506001","HYDROXYZINE HCL","10 MG","30","Select","Select",""],["","23601009760","ALUM CRUTCH MIS ADULT PB","","2","Select","Select",""],["","29300014901","QUETIAPINE TAB","100MG","30","Select","Select",""],["","31722016930","DULOXETINE CAP","30MG","30","Select","Select",""],["","29300046805","CLONIDINE TAB","0.1MG","60","Select","Select",""],["","00093506001","HYDROXYZ HCL TAB","10MG","30","Select","Select",""],["","59310057922","PROAIR HFA AER","","8","Select","Select",""],["","00406051201","OXYCOD\/APAP TAB","5-325MG","25","Select","Select",""],["","17478071130","LIDOCAINE GEL","2% JELLY","30","Select","Select",""],["","62559015710","POLYETH GLYC POW","3350 NF","20","Select","Select",""],["","65162046650","IBUPROFEN TAB","800MG","30","Select","Select",""],["","64380073706","VITAMIN D CAP","50000UNT","12","Select","Select",""],["","16714005501","MUPIROCIN CRE","2%","15","Select","Select",""],["","16714069101","FLUCONAZOLE TAB","100MG","8","Select","Select",""],["","00093101042","MUPIROCIN OIN","2%","22","Select","Select",""],["","29300022019","MONTELUKAST TAB","10MG","30","Select","Select",""],["","68180096301","ALBUTEROL AER HFA","","8","Select","Select",""],["","68462043730","OLMESA MEDOX TAB","20MG","90","Select","Select",""],["","69097012303","TOPIRAMATE TAB","50MG","30","Select","Select",""],["","82607066026","FLOWFLEX KIT TEST","","4","Select","Select",""],["","55111064505","OMEPRAZOLE CAP","40MG","180","Select","Select",""],["","31722071530","ATOMOXETINE CAP","18MG","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":""}]}]}