{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KARENA COOKE","gend":1,"add":"1427 KOPEK CT","city":"HAMPTON","state":"VA","zip":"23666-9998","dob":"1985-11-17","age":"","mstatus":"","insh":"3955907*01","cliId":"","pno":7573166503,"cno":7573166503,"email":"","ename":"","eno":"","pphy":"QUIDGLEY-NEVARES, ANTONIO MD","ppno":7573106413,"pcpadd":"1030 LOFTIS BLVD SUITE 201,","pcpcity":"NEWPORT NEWS","pcpstate":"VA","pcpzip":"23606-9998","pcpcounty":"","pcpid":"","pcpname":"EVMS Physical Medicine & Rehabilitation","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7579350242,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I10.","K21.9","D50.9","G43.119","M54.2","M51.37","E66.9","Z13.6","G89.29","Z76.89","G43.009","E66.01","Z68.36","R55.","R00.2","R07.9","S13.4XXA","S33.5XXA","S43.91XA","M54.12","J01.00","H60.93","R07.89","NO DATA","Z88.1","Z79.899","R06.02","H00.024","M62.81","M25.562","R35.0","N76.0","G47.33","M25.511","M47.812","Z01.419","Z20.2","Z00.00","G43.011","M54.9","R29.6","R29.898","R25.3","R53.83","Z87.898","H66.91","R56.9","G40.909","G89.4","I49.1","I49.3","M79.7","R10.2","M54.16","R53.82","M54.42","M54.41","Z91.81","L03.818","R51.9","G43.809","Z88.2","R07.1","Z20.828","M79.89","H57.12","H52.13","M25.473","J06.9","M54.5","R20.0","R10.84"],"date":["2023-04-26","2021-01-18","2021-01-18","2021-01-18","2023-06-01","2021-01-18","2021-01-18","2021-01-18","2023-02-27","2021-01-18","2023-04-12","2021-02-17","2021-02-17","2022-10-20","2022-09-02","2023-02-07","2022-03-27","2022-03-27","2022-03-27","2023-06-02","2022-06-23","2022-06-23","2022-09-29","2023-05-19","2022-09-29","2023-02-07","2023-02-07","2023-05-04","2023-06-01","2023-05-19","2021-02-12","2021-02-12","2021-03-11","2022-04-28","2022-04-28","2022-03-01","2022-03-01","2022-03-01","2022-04-01","2022-04-01","2022-04-01","2023-02-27","2022-04-01","2022-04-01","2022-04-01","2023-07-08","2023-04-12","2023-03-10","2023-06-02","2022-03-30","2022-03-30","2023-06-02","2022-09-13","2023-06-02","2023-01-25","2023-01-25","2023-01-04","2021-12-29","2021-02-07","2023-03-10","2022-09-15","2022-09-15","2022-09-29","2021-11-03","2023-02-27","2023-03-10","2023-03-10","2023-04-12","2021-11-03","2021-04-28","2023-02-07","2023-07-09"],"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":[["","23155000810","HYDROCHLOROT TAB","25MG","90","Select","Select",""],["","00093342210","CYCLOBENZAPR TAB","10MG","45","Select","Select",""],["","59746000103","METHYLPRED TAB","4MG","21","Select","Select",""],["","00378064205","PREDNISONE TAB","20MG","21","Select","Select",""],["","65162019050","NAPROXEN TAB","500MG","30","Select","Select",""],["","10702025350","BUT\/APAP\/CAF TAB","","30","Select","Select",""],["","76385012350","METHOCARBAM TAB","500MG","30","Select","Select",""],["","67877021560","CEFUROXIME TAB","250MG","20","Select","Select",""],["","68180072103","AMLODIPINE TAB","10MG","90","Select","Select",""],["","00093005805","TRAMADOL HCL TAB","50MG","20","Select","Select",""],["","51285036601","TREXALL TAB","5MG","4","Select","Select",""],["","00378001401","METHOTREXATE TAB","2.5MG","8","Select","Select",""],["","43598032675","CIPRO\/DEXA SUS","0.3-0.1%","8","Select","Select",""],["","65862039010","ONDANSETRON TAB","4MG ODT","12","Select","Select",""],["","42291040030","LIDOCAINE CRE","5%","100","Select","Select",""],["","43598029190","PREGABALIN CAP","25MG","90","Select","Select",""],["","00093216568","NALOXONE HCL SPR","4MG","2","Select","Select",""],["","53746010901","HYDROCO\/APAP TAB","5-325MG","90","Select","Select",""],["","69097015907","MELOXICAM TAB","15MG","15","Select","Select",""],["","00555902742","JUNEL","1.5-0.03MG","21","Select","Select",""],["","43598029490","PREGABALIN","100 MG","90","Select","Select",""],["","69097015907","MELOXICAM","15 MG","30","Select","Select",""],["","72578009621","TIZANIDINE HCL","2 MG","90","Select","Select",""],["","51672401801","ETODOLAC","400 MG","30","Select","Select",""],["","68180072003","AMLODIPINE BESYLATE","5 MG","180","Select","Select",""],["","00093342210","CYCLOBENZAPRINE HCL","10 MG","90","Select","Select",""],["","68462015713","ONDANSETRON ODT","4 MG","12","Select","Select",""],["","70752011304","LIDOCAINE","5 %","100","Select","Select",""],["","49483060450","IBUPROFEN","800 MG","60","Select","Select",""],["","24208091055","ERYTHROMYCIN","5 MG\/GRAM","3.5","Select","Select",""],["","10702025350","BUTALBITAL-ACETAMINOPHEN-CAFFE","50-325-40","30","Select","Select",""],["","00143993905","AMOXICILLIN","500 MG","30","Select","Select",""],["","53746010901","HYDROCODONE-ACETAMINOPHEN","5 MG-325MG","90","Select","Select",""],["","23155000810","HYDROCHLOROTHIAZIDE","25 MG","90","Select","Select",""],["","70710113908","FLUCONAZOLE","150 MG","1","Select","Select",""],["","49483034010","ACETAMINOPHEN","325 MG","30","Select","Select",""],["","65862098799","POTASSIUM CHLORIDE","10 MEQ","14","Select","Select",""],["","63304069301","CLINDAMYCIN HCL","300 MG","28","Select","Select",""],["","00378668910","PANTOPRAZOLE SODIUM","40 MG","30","Select","Select",""],["","65862050220","AMOXICILLIN-CLAVULANATE POTASS","500-125 MG","20","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":""}]}]}