{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LAMONT BARLOW","gend":0,"add":"4 CORNELL DR","city":"HAMPTON","state":"VA","zip":"23669-9998","dob":"1982-07-15","age":"","mstatus":"","insh":"20073380*01","cliId":"","pno":7577688118,"cno":7577688118,"email":"","ename":"","eno":"","pphy":"ARNOLD, HELEN G DO","ppno":7579300091,"pcpadd":"12715 WARWICK BLVD STE O,","pcpcity":"NEWPORT NEWS","pcpstate":"VA","pcpzip":"23606-9998","pcpcounty":"","pcpid":"","pcpname":"Commonwealth Family Practice","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7572694406,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["B20.","F17.200","Z00.00","F32.9","R53.82","A63.0","C81.28","C78.7","G62.9","M89.9","D72.819","Z86.79","Z85.05","Z92.21","N48.9","J43.2","Z71.9","G47.00","Z86.19","D09.9","Z85.71","Z68.28","Z23.","J44.9","K62.89","G89.29","G62.0","T45.1X5A","C49.5","D70.9","N50.82","I86.1","T80.212A","L03.313","G89.3","J43.9","R11.0","Z79.899","Z87.891","N50.811","R85.610","C79.51","F17.210","Z01.812","Z20.822","C85.85","D70.8","Z13.220","D09.8","Z08."],"date":["2023-08-29","2022-02-18","2021-08-12","2021-11-11","2021-08-12","2023-06-13","2023-04-28","2023-04-28","2023-07-24","2021-08-17","2023-07-24","2022-05-12","2022-11-01","2023-06-13","2021-04-02","2022-08-02","2021-06-14","2022-08-02","2021-11-11","2023-06-16","2023-07-24","2023-06-13","2023-08-29","2022-02-18","2023-05-16","2023-05-16","2023-02-02","2023-02-02","2021-09-27","2022-02-10","2023-02-02","2021-11-11","2021-03-02","2021-03-02","2021-03-02","2021-03-02","2021-03-02","2021-03-02","2021-03-02","2021-06-09","2021-05-05","2023-01-31","2021-06-09","2021-09-23","2021-09-23","2021-07-13","2021-04-21","2023-05-16","2023-07-13","2023-07-24"],"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":[["","65862042001","SMZ\/TMP DS","TAB 800-160","12","Select","Select",""],["","00406051201","OXYCOD\/APAP","TAB 5-325MG","10","Select","Select",""],["","00023611803","CONDYLOX","GEL 0.005","4","Select","Select",""],["","00173087310","INCRUSE ELPT","INH 62.5MCG","30","Select","Select",""],["","61958250101","BIKTARVY","50-200-25","30","Select","Select",""],["","59310057922","PROAIR HFA","AER ","8","Select","Select",""],["","00173069700","ADVAIR DISKU","AER 500\/50","60","Select","Select",""],["","65162091838","LIDOCAINE","5 %","35.44","Select","Select",""],["","00093506101","HYDROXYZ HCL","TAB 25MG","30","Select","Select",""],["","10135013601","DOCUSATE SODIUM","250 MG","90","Select","Select",""],["","10939033433","FIBER LAXATIVE","500 MG","360","Select","Select",""],["","00135019902","CITRUCEL","500 MG","360","Select","Select",""],["","11822333810","SOLUBLE FIBER","500 MG","360","Select","Select",""],["","65862052790","VENLAFAXINE HCL ER","37.5 MG","63","Select","Select",""],["","65862042001","SMZ\/TMP DS TAB","800-160","12","Select","Select",""],["","61958250101","BIKTARVY TAB","","30","Select","Select",""],["","65162091838","LIDOCAINE OIN","5%","35","Select","Select",""],["","00406051201","OXYCODONE-ACETAMINOPHEN","5 MG-325MG","20","Select","Select",""],["","43598021085","SSD","1 %","85","Select","Select",""],["","00406012305","HYDROCODONE-ACETAMINOPHEN","5 MG-325MG","30","Select","Select",""],["","00496088271","LMX","4 4%","1","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":""}]}]}