{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"NATHANIEL GOODMAN","gend":0,"add":"7806 FOREST HILL AVE","city":"RICHMOND","state":"VA","zip":"23225-9998","dob":"1962-11-24","age":"","mstatus":"","insh":"2180926*01","cliId":"","pno":7572471879,"cno":7572471879,"email":"","ename":"","eno":"","pphy":"SUTTON, SIDNEY MICHAEL MD","ppno":2523384400,"pcpadd":"711 ROANOKE AVE,","pcpcity":"ELIZABETH CITY","pcpstate":"NC","pcpzip":"27909-9998","pcpcounty":"","pcpid":"","pcpname":"APS - Sentara Family Medicine Physicians - North Road St","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":2523377907,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F32.9","V62.84","F33.3","F14.20","F15.20","F10.20","F25.0","L50.9","Z21.","L29.8","F14.90","F32.89","F20.9","Z20.822","R45.0","B20.","N39.0","F17.210","Z71.6","T78.2XXA","T78.3XXA","T88.7XXA","T36.95XA","T78.40XA","F19.959","F60.9","Z86.59","F14.10","F32.2","F25.9","F19.10","R00.0","Z20.828","F90.2","Z59.0","Z04.9","F33.2","M54.32","Z79.899","M79.605","F60.0","R41.82","M79.641","F06.4","NO DATA","Z59.00","Z56.0","F31.9","T37.1X5A","Z87.891","R94.6","E55.9","B18.1","D69.6","D70.9","Z11.1"],"date":["2021-10-19","2022-01-07","2022-01-08","2022-01-19","2021-10-30","2023-08-16","2022-01-19","2022-09-14","2022-09-22","2022-09-14","2021-09-04","2022-01-05","2022-09-21","2022-01-05","2022-01-05","2023-06-23","2022-01-08","2022-01-13","2022-01-13","2022-09-22","2022-09-23","2022-09-23","2022-09-23","2022-09-23","2021-08-26","2021-08-26","2021-08-26","2022-01-07","2022-01-13","2021-10-19","2021-10-19","2021-08-24","2022-01-03","2021-08-26","2021-08-29","2021-10-18","2022-01-07","2022-06-29","2023-06-23","2022-06-29","2021-08-24","2021-08-29","2021-08-29","2022-01-19","2021-10-18","2021-10-18","2021-10-18","2022-09-21","2022-09-21","2022-09-21","2022-09-21","2023-06-23","2023-06-23","2023-06-23","2023-06-23","2023-06-23"],"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":[["","43547034350","RISPERIDONE","TAB 3MG","30","Select","Select",""],["","00378641001","DOXEPIN HCL","CAP 100MG","31","Select","Select",""],["","61958250101","BIKTARVY","50-200-25","30","Select","Select",""],["","68462010530","ONDANSETRON","TAB 4MG","9","Select","Select",""],["","68001018508","QUETIAPINE","TAB 25MG","65","Select","Select",""],["","29300012510","MELOXICAM","TAB 15MG","30","Select","Select",""],["","55111053405","DIVALPROEX","TAB 500MG ER","60","Select","Select",""],["","65162062711","TRAMADOL HCL","TAB 50MG","7","Select","Select",""],["","33342007007","OLANZAPINE","TAB 10MG","60","Select","Select",""],["","10370010150","BUPROPN HCL","TAB 150MG XL","15","Select","Select",""],["","50111056102","TRAZODONE","TAB 100MG","30","Select","Select",""],["","23155050105","HYDROXYZ HCL","TAB 25MG","30","Select","Select",""],["","68001043488","NICOTINE TD","DIS STEP 1","30","Select","Select",""],["","68001041408","DULOXETINE","CAP 30MG","90","Select","Select",""],["","57237000830","MIRTAZAPINE","TAB 15MG","30","Select","Select",""],["","63402030230","LATUDA","20 MG","30","Select","Select",""],["","65862007701","CIPROFLOXACN","TAB 500MG","20","Select","Select",""],["","65862042005","SMZ\/TMP DS","TAB 800-160","30","Select","Select",""],["","70954006020","PREDNISONE","TAB 20MG","18","Select","Select",""],["","00172572860","FAMOTIDINE","TAB 20MG","28","Select","Select",""],["","31722053401","METHOCARBAM","TAB 750MG","30","Select","Select",""],["","33332032203","AFLURIA QUAD","INJ 2022-23","0","Select","Select",""],["","80777028205","MODERNA BIVA","INJ BA4\/BA5","0","Select","Select",""],["","72205020730","LURASIDONE HCL","20 MG","30","Select","Select",""],["","60505265401","TRAZODONE HCL","100 MG","60","Select","Select",""],["","65862007701","CIPROFLOXACN TAB","500MG","20","Select","Select",""],["","61958250101","BIKTARVY TAB","","30","Select","Select",""],["","65862042005","SMZ\/TMP DS TAB","800-160","30","Select","Select",""],["","43547034350","RISPERIDONE TAB","3MG","30","Select","Select",""],["","59746017506","PREDNISONE TAB","20MG","18","Select","Select",""],["","31722053401","METHOCARBAM TAB","750MG","30","Select","Select",""],["","00093506105","HYDROXYZ HCL TAB","25MG","30","Select","Select",""],["","33332032203","AFLURIA QUAD INJ","2022-23","0","Select","Select",""],["","00172572860","FAMOTIDINE TAB","20MG","28","Select","Select",""],["","80777028205","MODERNA BIVA INJ BA","4\/BA5","0","Select","Select",""],["","63402030230","LATUDA TAB","20MG","5","Select","Select",""],["","27241009903","DULOXETINE HCL","60 MG","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":""}]}]}