{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ELIZABETH  A GRIFFIN","gend":1,"add":"16 HAMPSHIRE DR","city":"HAMPTON","state":"VA","zip":"23669-9998","dob":"1978-12-13","age":"","mstatus":"","insh":"2425134*01","cliId":"","pno":7579334580,"cno":7579334580,"email":"","ename":"","eno":"","pphy":"VALERIO, HERNANI A MD","ppno":7579300091,"pcpadd":"12715 WARWICK BOULEVARD STE M O,","pcpcity":"NEWPORT NEWS","pcpstate":"VA","pcpzip":"23606-9998","pcpcounty":"","pcpid":"","pcpname":"Commonwealth Family Practice","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7572694406,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R29.818","F11.20","L03.113","S70.01XA","F17.210","Z88.2","Z88.8","Z88.6","Z91.030","Z91.041","Z91.038","Z88.5","Z91.010","Z91.013","M25.551","F17.200","Z13.89","Z51.81","F41.8","K59.09","E87.6","R56.9","F10.20","Z86.19","F14.90","R32.","F10.239","F33.3","K51.90","T42.6X4A","T42.8X4A","S09.90XA","S61.519A","F14.23","K21.9","F41.9","G40.909","Z87.11","Z90.49","Z86.010","S31.811A","T74.31XA","E86.0","F14.10","F10.10","R46.89","F10.21","F14.21","F31.4","F60.3","S39.82XA","M79.601","NO DATA","F19.90","F43.10","Z32.02","Z01.419","N91.2","N81.2","N39.46","N81.10","T42.71XA","F19.930","R74.01","T42.72XA","Z23.","Z85.828","L71.9","I78.1","L81.4","D22.9","L82.1","Z12.83","Z71.9","F19.10","T50.902A","Z20.822","I87.2","Z79.899","R11.0","K51.919","R52.","Z68.21","R41.82","R93.0","F10.14","Z13.0","F43.20","F10.129","N39.0"],"date":["2021-11-08","2022-02-08","2021-12-18","2021-12-18","2023-06-05","2021-12-18","2021-12-18","2021-12-18","2021-12-18","2021-12-18","2021-12-18","2021-12-18","2021-12-18","2021-12-18","2021-12-18","2022-01-31","2022-01-31","2022-01-31","2023-06-05","2023-06-05","2022-04-25","2022-04-25","2022-02-15","2022-02-15","2022-02-15","2022-06-20","2021-11-07","2022-04-25","2021-11-07","2021-11-07","2021-11-07","2021-11-07","2021-11-07","2021-11-07","2022-01-06","2022-03-17","2021-11-10","2021-11-07","2021-11-15","2021-11-07","2021-11-15","2021-11-15","2021-11-15","2023-06-05","2022-01-03","2021-11-14","2021-11-28","2021-11-28","2021-11-28","2021-11-28","2021-11-07","2022-01-04","2023-01-30","2022-01-04","2022-01-04","2022-03-17","2022-03-17","2022-03-17","2022-03-17","2022-05-05","2022-06-20","2021-11-10","2021-11-08","2021-11-10","2021-11-07","2022-04-25","2022-04-25","2022-07-07","2022-07-07","2022-07-07","2022-07-07","2022-07-07","2022-07-07","2022-07-07","2021-11-09","2021-11-09","2021-11-15","2022-01-06","2022-01-06","2022-01-06","2023-01-30","2023-04-07","2023-04-07","2023-05-14","2023-06-05","2023-06-05","2023-06-05","2023-05-13","2023-05-13","2023-05-13"],"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":[["","67877021905","CEPHALEXIN","500 MG","14","Select","Select",""],["","52817031910","BACLOFEN","TAB 5MG","30","Select","Select",""],["","12496120803","SUBOXONE","MIS 8-2MG","25","Select","Select",""],["","70010010801","GABAPENTIN","CAP 100MG","60","Select","Select",""],["","49483034010","ACETAMIN","TAB 325MG","30","Select","Select",""],["","65162046510","IBUPROFEN","TAB 600MG","90","Select","Select",""],["","16714008310","HYDROXYZ HCL","TAB 50MG","30","Select","Select",""],["","62756018488","OXCARBAZEPIN","TAB 300MG","90","Select","Select",""],["","80681008600","MELATONIN","TAB 3MG","14","Select","Select",""],["","68462039610","OMEPRAZOLE","CAP 20MG","30","Select","Select",""],["","63402030230","LATUDA","TAB 20MG","30","Select","Select",""],["","29300014801","QUETIAPINE","TAB 50MG","90","Select","Select",""],["","68382005001","MELOXICAM","TAB 7.5MG","30","Select","Select",""],["","00093216568","NALOXONE HCL","SPR ","2","Select","Select",""],["","00904699880","DOCUSATE SOD","CAP 100MG","20","Select","Select",""],["","00904772512","ANTI-DIARRHE","TAB 2MG","24","Select","Select",""],["","68382004001","PROMETHAZINE","TAB 12.5MG","30","Select","Select",""],["","49348092710","SM IBUPROFEN","TAB 200MG","180","Select","Select",""],["","00310027810","SEROQUEL","TAB 50MG","30","Select","Select",""],["","47781035703","BUPREN\/NALOX","MIS 8-2MG","25","Select","Select",""],["","71093014005","METHOCARBAM","TAB 500MG","30","Select","Select",""],["","41167005840","ASPERCREME","PAD LIDO 4%","10","Select","Select",""],["","50111056001","TRAZODONE","TAB 50MG","7","Select","Select",""],["","69547035302","NARCAN","SPR ","2","Select","Select",""],["","00781717612","NALOXONE","SPR ","2","Select","Select",""],["","45802086866","POLYETH GLYC","POW 3350 NF","14","Select","Select",""],["","69618003206","SIMETHICONE","CHW 125MG","60","Select","Select",""],["","59746017509","PREDNISONE","TAB 20MG","10","Select","Select",""],["","00536106210","STOOL SOFTNR","CAP 100MG","60","Select","Select",""],["","11822013729","RA COL-RITE","CAP 100MG","60","Select","Select",""],["","00555077902","MEDROXYPR AC","TAB 10MG","10","Select","Select",""],["","43598044828","NICOTINE TD","DIS 21MG\/24H","28","Select","Select",""],["","65862021150","MINOCYCLINE","CAP 100MG","30","Select","Select",""],["","57237001830","DULOXETINE","CAP 30MG","90","Select","Select",""],["","65862052890","VENLAFAXINE","CAP 75MG ER","30","Select","Select",""],["","00713063337","METRONIDAZOL","CRE 0.0075","45","Select","Select",""],["","00115180401","HYDROXYZINE PAMOATE","50 MG","30","Select","Select",""],["","62756018488","OXCARBAZEPINE","300 MG","60","Select","Select",""],["","65862052790","VENLAFAXINE HCL ER","37.5 MG","30","Select","Select",""],["","11822013729","COL-RITE","100 MG","180","Select","Select",""],["","69315090510","LORAZEPAM","1 MG","5","Select","Select",""],["","43292012345","VITAMIN B-","1 100 MG","3","Select","Select",""],["","55111011901","FAMOTIDINE","20 MG","60","Select","Select",""],["","00378623101","CITALOPRAM HBR","10 MG","30","Select","Select",""],["","16714008310","HYDROXYZ HCL TAB","50MG","30","Select","Select",""],["","59746017506","PREDNISONE TAB","20MG","10","Select","Select",""],["","29300014801","QUETIAPINE TAB","50MG","90","Select","Select",""],["","70010010801","GABAPENTIN CAP","100MG","60","Select","Select",""],["","00536106210","STOOL SOFTNR CAP","100MG","60","Select","Select",""],["","63402030230","LATUDA TAB","20MG","30","Select","Select",""],["","68462039610","OMEPRAZOLE CAP","20MG","30","Select","Select",""],["","12496120803","SUBOXONE MIS","8-2MG","25","Select","Select",""],["","62756018488","OXCARBAZEPIN TAB","300MG","90","Select","Select",""],["","47781035703","BUPREN\/NALOX MIS","8-2MG","25","Select","Select",""],["","65162046510","IBUPROFEN TAB","600MG","90","Select","Select",""],["","11822013729","RA COL-RITE CAP","100MG","60","Select","Select",""],["","43598044828","NICOTINE TD DIS","21MG\/24H","28","Select","Select",""],["","00555077902","MEDROXYPR AC TAB","10MG","10","Select","Select",""],["","65862021150","MINOCYCLINE CAP","100MG","30","Select","Select",""],["","57237001830","DULOXETINE CAP","30MG","90","Select","Select",""],["","65862052890","VENLAFAXINE CAP","75MG ER","30","Select","Select",""],["","00713063337","METRONIDAZOL CRE","0.75%","45","Select","Select",""],["","59762005101","METHYLPREDNISOLONE","32 MG","2","Select","Select",""],["","00904530760","BANOPHEN","50 MG","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":""}]}]}