{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"STEPHANIE VANHOUDT","gend":1,"add":"6950 WAREHOUSE ROAD","city":"GLOUCESTER","state":"VA","zip":"23061-9998","dob":"1985-12-18","age":"","mstatus":"","insh":"2216420*01","cliId":"","pno":8048545457,"cno":8048545457,"email":"","ename":"","eno":"","pphy":"LONG, JAMES B MD","ppno":8046932720,"pcpadd":"SUITE 2200 7547 MEDICAL DRIVE,","pcpcity":"GLOUCESTER","pcpstate":"VA","pcpzip":"23061-9998","pcpcounty":"","pcpid":"","pcpname":"Internal Medicine Associates of Gloucester","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":8046940597,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F11.20","F12.10","F31.9","F41.1","Z72.0","F90.0","G47.00","F41.8","R44.1","L03.011","N39.0","B96.89","F14.10","F11.10","F20.9","L03.114","D72.829","F17.210","S61.001A","K76.9","R53.83","S42.452A","R50.9","L02.512","E87.6","F19.10","F11.23","F14.23","F10.239","Z62.810","F31.81","L02.511","J06.9","F11.90","F41.9","Z20.822","Z87.442","Z90.49","Z00.8","F33.1","R00.0","M25.522","F19.90","L03.113","Z09.","K74.60","F10.10","Z79.899","Z86.79","R05.9","R09.81","I49.9","R11.2","T76.21XA","S39.012A","K70.30","B18.2","I46.9"],"date":["2022-03-29","2021-12-08","2021-12-08","2022-02-27","2021-05-25","2021-05-25","2021-05-25","2021-12-08","2021-12-08","2021-12-08","2021-12-08","2021-12-08","2021-12-08","2021-12-08","2022-10-05","2021-10-21","2021-06-27","2023-02-22","2021-08-06","2021-08-06","2021-08-06","2021-10-21","2021-11-04","2021-07-03","2021-07-03","2022-02-04","2022-02-04","2021-08-06","2021-08-08","2021-08-06","2022-10-23","2021-10-21","2021-11-04","2021-11-04","2021-12-08","2022-02-04","2023-02-22","2021-12-08","2021-12-08","2022-02-27","2021-10-21","2021-10-21","2021-10-21","2022-05-10","2021-08-01","2021-10-21","2021-10-21","2021-10-21","2021-10-21","2021-11-04","2021-11-04","2021-12-09","2022-02-04","2023-02-22","2023-02-22","2023-02-22","2023-03-30","2023-06-12"],"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":[["","43598058230","BUPREN\/NALOX","MIS 8-2MG","10","Select","Select",""],["","12496120803","SUBOXONE","MIS 8-2MG","21","Select","Select",""],["","68645056354","IBUPROFEN","TAB 800MG","9","Select","Select",""],["","57237007810","ONDANSETRON","TAB 8MG ODT","15","Select","Select",""],["","67877025001","QUETIAPINE","TAB 100MG","30","Select","Select",""],["","43547028950","BUPROPION","TAB 150MG SR","60","Select","Select",""],["","69547035302","NARCAN","SPR ","2","Select","Select",""],["","50228017705","GABAPENTIN","TAB 600MG","42","Select","Select",""],["","60505283303","ATOMOXETINE","CAP 40MG","30","Select","Select",""],["","00172392670","DIAZEPAM","TAB 5MG","3","Select","Select",""],["","68382070718","DOXYCYC MONO","CAP 100MG","14","Select","Select",""],["","00093005805","TRAMADOL HCL","TAB 50MG","15","Select","Select",""],["","31722054501","LITHIUM CARB","CAP 300MG","30","Select","Select",""],["","65162027250","SMZ\/TMP DS","TAB 800-160","20","Select","Select",""],["","43598044828","NICOTINE TD","DIS 21MG\/24H","7","Select","Select",""],["","00172572860","FAMOTIDINE","TAB 20MG","15","Select","Select",""],["","00093101042","MUPIROCIN","OIN 0.02","22","Select","Select",""],["","67877021905","CEPHALEXIN","CAP 500MG","21","Select","Select",""],["","68180044601","QUETIAPINE FUMARATE","50 MG","30","Select","Select",""],["","00093005405","BUSPIRONE HCL","10 MG","60","Select","Select",""],["","65862017260","TOPIRAMATE","50 MG","60","Select","Select",""],["","00172572860","FAMOTIDINE TAB","20MG","15","Select","Select",""],["","57237007810","ONDANSETRON TAB","8MG ODT","15","Select","Select",""],["","43598058230","BUPREN\/NALOX MIS","8-2MG","10","Select","Select",""],["","67877025001","QUETIAPINE TAB","100MG","30","Select","Select",""],["","12496120803","SUBOXONE MIS","8-2MG","15","Select","Select",""],["","50268028115","DOXYCYC MONO CAP","100MG","14","Select","Select",""],["","00093101042","MUPIROCIN OIN","2%","22","Select","Select",""],["","67877021905","CEPHALEXIN CAP","500MG","21","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":""}]}]}