{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SAMANTHA SYDLO","gend":1,"add":"1751 PARRISH ST","city":"CHESAPEAKE","state":"VA","zip":"23324-9998","dob":"1989-05-18","age":"","mstatus":"","insh":"2403226*01","cliId":"","pno":7577454810,"cno":7577454810,"email":"","ename":"","eno":"","pphy":"NEGRON, KIRSTIN H DO","ppno":7573051797,"pcpadd":"828 HEALTHY WAY STE 220,","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":"23462-9998","pcpcounty":"","pcpid":"","pcpname":"Bon Secours Medical Associates","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7573094715,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E66.3","Z76.89","F90.2","Z51.81","D50.9","Z11.59","Z11.3","Z91.138","N92.0","K91.2","Z79.899","R53.82","F41.1","O34.211","O99.02","D64.9","Z37.0","O99.214","E66.9","Z3A.39","O99.844","O99.344","F32.9","Z23.","R32.","M65.4","Z68.38","O34.219","Z39.2","Z13.31","Z30.9","Z30.017","Z32.02","V58.69","Z98.84","F90.9","G43.009","Z80.3","O99.893","T23.102A","R63.5","O99.345","NO DATA","Z68.36","Z97.5","N92.1","O90.0","Z30.46","Z30.09","N91.1","V23.87","Z34.80","O21.9"],"date":["2021-04-20","2022-03-08","2022-09-06","2022-06-14","2022-06-14","2022-03-08","2022-03-08","2022-04-22","2022-06-14","2022-06-14","2022-04-22","2022-06-14","2022-09-06","2021-01-08","2021-01-08","2021-01-08","2021-01-08","2021-01-08","2021-01-08","2021-01-08","2021-01-08","2021-01-08","2021-01-08","2021-10-11","2021-01-08","2021-10-11","2021-10-11","2021-01-08","2021-03-03","2021-03-03","2021-03-03","2021-03-03","2021-03-03","2022-04-22","2022-04-22","2021-06-01","2021-06-01","2022-06-14","2021-01-07","2021-07-06","2021-03-09","2021-03-09","2021-03-09","2021-03-09","2022-05-13","2022-05-13","2021-01-27","2023-07-19","2023-07-19","2023-09-20","2023-09-20","2023-09-20","2023-09-20"],"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":[["","00527551537","AMPHET\/DEXTR CAP","30MG ER","30","Select","Select",""],["","57844011001","ADDERALL TAB","10MG","30","Select","Select",""],["","54092039101","ADDERALL XR CAP","30MG","30","Select","Select",""],["","31722015701","AMPHET\/DEXTR TAB","10MG","30","Select","Select",""],["","65862042001","SMZ\/TMP DS TAB","800-160","28","Select","Select",""],["","00781185220","AMOX\/K CLAV TAB","875-125","14","Select","Select",""],["","68180084473","KURVELO TAB","0.15\/30","28","Select","Select",""],["","59417010410","VYVANSE CAP","40MG","30","Select","Select",""],["","57844011001","ADDERALL","TAB 10MG","30","Select","Select",""],["","68382095201","AMPHET\/DEXTR","TAB 10MG","30","Select","Select",""],["","54092039101","ADDERALL XR","CAP 30MG","30","Select","Select",""],["","65862042001","SMZ\/TMP DS","TAB 800-160","28","Select","Select",""],["","68180084473","KURVELO","TAB 0.15\/30","28","Select","Select",""],["","00781185220","AMOX\/K CLAV","TAB 875-125","14","Select","Select",""],["","59417010410","VYVANSE","CAP 40MG","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":""}]}]}