{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DEMTHRIA PERKERSON","gend":1,"add":"3812 TOWNE POINT ROAD APT D","city":"PORTSMOUTH","state":"VA","zip":"23703-9998","dob":"1977-10-11","age":"","mstatus":"","insh":"2426293*01","cliId":"","pno":7573053103,"cno":7573053103,"email":"","ename":"","eno":"","pphy":"MAPANAO, VIVIAN MD","ppno":7574837100,"pcpadd":"Bridge Road Family Medicine 4868 Br,","pcpcity":"SUFFOLK","pcpstate":"VA","pcpzip":"23435-9998","pcpcounty":"","pcpid":"","pcpname":"Bridge Road Family Medicine","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7574837150,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["C45.1","Z51.12","L66.9","Z71.9","D23.4","I82.C11","NO DATA","R07.9","I10.","E78.5","E66.9","Z87.891","J45.909","D86.9","M19.90","Z88.8","Z79.899","R10.33","R06.02","H11.33","Z98.890","Z88.1","R11.10","R59.0","N28.1","R73.03","E55.9","N64.4","K21.9","F41.8","C48.2","M54.2","G56.03","L21.0","R53.82","T82.524A","E66.01","Z68.42","Z79.84","R53.83","R68.81","R19.5","R15.2","R10.84","Z12.11","R19.7","M25.531","M54.9","D86.0","E83.52","C45.9","K63.5","K63.89","K62.1","R19.4","K29.70","G47.30","Z92.21"],"date":["2023-09-15","2023-09-15","2022-11-03","2022-10-05","2023-03-31","2023-09-08","2023-08-11","2023-06-12","2023-08-22","2023-06-12","2023-04-14","2022-10-12","2023-08-22","2022-08-16","2022-08-16","2022-08-16","2023-08-22","2023-06-23","2022-08-16","2022-10-12","2022-10-12","2022-10-12","2022-10-12","2023-01-05","2022-08-22","2023-06-12","2023-03-10","2023-03-10","2023-08-22","2023-03-10","2023-03-10","2022-08-05","2023-06-12","2022-08-05","2022-08-05","2022-10-11","2023-08-22","2023-08-22","2022-10-11","2023-05-24","2023-04-14","2023-04-14","2023-04-14","2023-04-14","2023-08-22","2023-09-08","2023-06-12","2023-06-12","2023-06-12","2023-06-12","2023-05-22","2023-08-22","2023-08-22","2023-08-22","2023-08-22","2023-08-22","2023-08-22","2023-07-10"],"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":[["","00228203110","ALPRAZOLAM","1 MG","3","Select","Select",""],["","60505265605","TRIAMT\/HCTZ","TAB 37.5-25","90","Select","Select",""],["","29300041519","CYCLOBENZAPR","TAB 10MG","30","Select","Select",""],["","55111064530","OMEPRAZOLE","40 MG","90","Select","Select",""],["","29300022019","MONTELUKAST","TAB 10MG","30","Select","Select",""],["","68645056354","IBUPROFEN","TAB 800MG","30","Select","Select",""],["","63646001004","KETOCONAZOLE","SHA 0.02","120","Select","Select",""],["","50383066730","LIDO\/PRILOCN","CRE 2.5-2.5%","30","Select","Select",""],["","72205002790","ROSUVASTATIN","TAB 5MG","30","Select","Select",""],["","31722070190","LOSARTAN POT","TAB 50MG","90","Select","Select",""],["","49035023814","EQ STOOL","CAP SOFTENER","270","Select","Select",""],["","42858000101","OXYCODONE","TAB 5MG","8","Select","Select",""],["","00904699880","DOCUSATE SOD","CAP 100MG","90","Select","Select",""],["","13107001401","GLYCOPYRROL","TAB 1MG","90","Select","Select",""],["","21922001704","CLOBETASOL","OIN 0.0005","30","Select","Select",""],["","69238110002","DOXYCYCL HYC","CAP 100MG","60","Select","Select",""],["","60505265605","TRIAMTERENE-HYDROCHLOROTHIAZID","37.5-25 MG","90","Select","Select",""],["","69315013901","GLYCOPYRROLATE","1 MG","30","Select","Select",""],["","29300022019","MONTELUKAST SODIUM","10 MG","30","Select","Select",""],["","72205000290","ROSUVASTATIN CALCIUM","5 MG","30","Select","Select",""],["","31722070190","LOSARTAN POTASSIUM","50 MG","30","Select","Select",""],["","00904699880","DOCUSATE SODIUM","100 MG","90","Select","Select",""],["","66993001968","ALBUTEROL SULFATE HFA","90 MCG","18","Select","Select",""],["","49035023814","STOOL SOFTENER","100 MG","90","Select","Select",""],["","76439030910","HYOSCYAMINE SULFATE","0.125 MG","120","Select","Select",""],["","68047025301","OSCIMIN SL","0.125 MG","120","Select","Select",""],["","72578005518","DOXYCYCLINE HYCLATE","100 MG","60","Select","Select",""],["","24486060110","HYOMAX-SL","0.125 MG","120","Select","Select",""],["","60505265605","TRIAMT\/HCTZ TAB","37.5-25","90","Select","Select",""],["","29300041519","CYCLOBENZAPR TAB","10MG","30","Select","Select",""],["","50383066730","LIDO\/PRILOCN CRE","2.5-2.5%","30","Select","Select",""],["","63646001004","KETOCONAZOLE SHA","2%","120","Select","Select",""],["","29300022019","MONTELUKAST TAB","10MG","30","Select","Select",""],["","55111064530","OMEPRAZOLE CAP","40MG","30","Select","Select",""],["","13107001401","GLYCOPYRROL TAB","1MG","30","Select","Select",""],["","68645056354","IBUPROFEN TAB","800MG","30","Select","Select",""],["","72205002790","ROSUVASTATIN TAB","5MG","30","Select","Select",""],["","00228202910","ALPRAZOLAM TAB","0.5MG","3","Select","Select",""],["","21922001704","CLOBETASOL OIN","0.05%","30","Select","Select",""],["","31722070190","LOSARTAN POT TAB","50MG","30","Select","Select",""],["","00904699880","DOCUSATE SOD CAP","100MG","90","Select","Select",""],["","49035023814","EQ STOOL CAP SOFTENER","","270","Select","Select",""],["","69238110002","DOXYCYCL HYC CAP","100MG","60","Select","Select",""],["","42858000101","OXYCODONE TAB","5MG","8","Select","Select",""],["","42806054701","VITAMIN D","2 1250 MCG","4","Select","Select",""],["","12843003520","PHILLIPS' LAXATIVE","100 MG","90","Select","Select",""],["","62332058231","LIDOCAINE-PRILOCAINE","2.5 %-2.5%","30","Select","Select",""],["","55111018015","TIZANIDINE HCL","4 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":""}]}]}