{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MARIA FINK","gend":1,"add":"2238 JEFFERSON AVE","city":"NEWPORT NEWS","state":"VA","zip":"23607-9998","dob":"1968-10-12","age":"","mstatus":"","insh":"9431780*01","cliId":"","pno":7579981927,"cno":7579981927,"email":"","ename":"","eno":"","pphy":"HERBERT, DWIGHT C MD","ppno":7575944431,"pcpadd":"12420 WARWICK BLVD BLDG 4 SUITE 4A,","pcpcity":"NEWPORT NEWS","pcpstate":"VA","pcpzip":"23606-9998","pcpcounty":"","pcpid":"","pcpname":"Riverside Primary Care - Hidenwood","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7575942936,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R05.9","R51.9","R06.7","Z20.822","U07.1","NO DATA","E66.01","I10.","E11.9","I83.023","N28.1","L97.329","Z79.01","Z86.718","Z68.43","I87.2","Z01.810","R06.02","G89.29","Z68.44","Z71.3","J98.8","B97.89","R53.83","Z86.711","K21.9","S52.122A","S02.2XXA","S16.1XXA","S00.83XA","D68.318","K30.","D50.9","Z01.818","E55.9","Z79.84","D64.9","I26.99","Z86.16","Z78.9","K90.9","Z98.84","Z68.42","F50.89","J01.00","R09.81","J06.9","H10.31","Z28.310","Z00.00","R76.8","J34.89","K76.0","K75.3","K66.0","R50.9","R52.","H25.13","H52.10","H04.123","E61.1","E53.8","E11.622","Z90.3","E11.40","W19.XXXA","R42.","Z91.81","M19.90","Z90.49","Z90.710","Z79.899"],"date":["2022-01-26","2022-01-14","2022-01-04","2022-01-04","2022-01-31","2022-01-31","2022-09-23","2022-09-23","2022-09-23","2022-06-27","2022-06-27","2022-06-27","2022-08-18","2022-08-18","2022-08-18","2022-09-23","2021-04-19","2022-01-26","2022-08-18","2021-09-27","2022-02-24","2021-12-27","2021-12-27","2021-12-27","2022-08-18","2021-11-17","2022-03-08","2022-03-15","2022-03-08","2022-03-08","2022-03-08","2021-02-08","2021-02-08","2022-06-27","2022-09-23","2022-08-18","2021-09-27","2022-01-26","2022-08-18","2022-03-02","2022-11-23","2022-11-23","2022-11-23","2021-09-07","2022-04-08","2022-04-08","2022-07-12","2022-04-08","2022-04-08","2022-07-20","2021-09-29","2022-03-15","2022-08-18","2022-08-18","2022-08-18","2022-01-14","2022-03-08","2022-04-15","2022-04-15","2022-04-15","2022-09-23","2022-09-23","2022-09-23","2022-09-23","2022-01-26","2022-03-08","2022-03-30","2022-03-30","2022-08-18","2022-08-18","2022-08-18","2022-08-18"],"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":[["","00169452414","WEGOVY INJ","2.4MG","3","Select","Select",""],["","43547035210","LISINOPRIL TAB","5MG","90","Select","Select",""],["","70010049101","METFORMIN TAB","500MG ER","30","Select","Select",""],["","62332025118","AZITHROMYCIN TAB","250MG","6","Select","Select",""],["","64380073706","VITAMIN D CAP","50000UNT","4","Select","Select",""],["","11822619070","RA COUGH DM SUS","30MG\/5ML","267","Select","Select",""],["","00003089421","ELIQUIS TAB","5MG","60","Select","Select",""],["","59746017506","PREDNISONE TAB","20MG","10","Select","Select",""],["","31722095801","BENZONATATE CAP","200MG","21","Select","Select",""],["","00172208380","HYDROCHLOROT TAB","25MG","90","Select","Select",""],["","00904759080","FEROSUL TAB","325MG","90","Select","Select",""],["","00406051201","OXYCOD\/APAP TAB","5-325MG","28","Select","Select",""],["","65162004710","OXYCODONE TAB","5MG","25","Select","Select",""],["","50228015801","CELECOXIB CAP","200MG","60","Select","Select",""],["","11822046713","PAIN RELIEF TAB","325MG","30","Select","Select",""],["","00093216568","NALOXONE HCL SPR","","2","Select","Select",""],["","70010010801","GABAPENTIN CAP","100MG","90","Select","Select",""],["","70010075401","METHOCARBAM TAB","500MG","40","Select","Select",""],["","31722099601","HYDROCO\/APAP TAB","5-325MG","15","Select","Select",""],["","57237002901","AMOXICILLIN TAB","875MG","20","Select","Select",""],["","68180096301","ALBUTEROL AER HFA","","8","Select","Select",""],["","53885027210","ONETOUCH TES VERIO","","100","Select","Select",""],["","53885000810","ONETOUCH DEL MIS PLUS","33G","100","Select","Select",""],["","38396031618","LANCET MICRO MIS THIN","33G","100","Select","Select",""],["","65162027210","SMZ\/TMP DS TAB","800-160","14","Select","Select",""],["","63824005632","MUCINEX DM TAB","30-600ER","20","Select","Select",""],["","16714001610","ENOXAPARIN INJ","40\/0.4ML","2","Select","Select",""],["","66993007996","FLUTICAS HFA AER","110MCG","12","Select","Select",""],["","60432026415","FLUTICASONE SPR","50MCG","16","Select","Select",""],["","00093220301","METOCLOPRAM TAB","10MG","40","Select","Select",""],["","00003089421","ELIQUIS","5 MG","180","Select","Select",""],["","42806054701","VITAMIN D","2 1250 MCG","4","Select","Select",""],["","00904759080","FEROSUL","325(65) MG","30","Select","Select",""],["","00169452414","WEGOVY","INJ 2.4MG","3","Select","Select",""],["","00172208380","HYDROCHLOROT","TAB 25MG","90","Select","Select",""],["","43547035210","LISINOPRIL","TAB 5MG","90","Select","Select",""],["","70010049101","METFORMIN","TAB 500MG ER","90","Select","Select",""],["","62332025118","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","64380071206","BENZONATATE","CAP 100MG","42","Select","Select",""],["","11822619070","RA COUGH DM","SUS 30MG\/5ML","267","Select","Select",""],["","59746017506","PREDNISONE","TAB 20MG","10","Select","Select",""],["","65162004710","OXYCODONE","TAB 5MG","25","Select","Select",""],["","00406051201","OXYCOD\/APAP","TAB 5-325MG","28","Select","Select",""],["","11822046713","PAIN RELIEF","TAB 325MG","30","Select","Select",""],["","00093216568","NALOXONE HCL","SPR ","2","Select","Select",""],["","31722099601","HYDROCO\/APAP","TAB 5-325MG","15","Select","Select",""],["","50228015801","CELECOXIB","CAP 200MG","60","Select","Select",""],["","70010010801","GABAPENTIN","CAP 100MG","180","Select","Select",""],["","70010075401","METHOCARBAM","TAB 500MG","40","Select","Select",""],["","57237002901","AMOXICILLIN","TAB 875MG","20","Select","Select",""],["","16714001610","ENOXAPARIN","INJ 40\/0.4ML","2","Select","Select",""],["","66993007996","FLUTICAS HFA","AER 110MCG","12","Select","Select",""],["","63824005632","MUCINEX DM","TAB 30-600ER","20","Select","Select",""],["","68180096301","ALBUTEROL","AER HFA","26","Select","Select",""],["","53885027210","ONETOUCH","TES VERIO","100","Select","Select",""],["","53885000810","ONETOUCH DEL","MIS PLUS 33G","100","Select","Select",""],["","38396031618","LANCET MICRO","MIS THIN 33G","100","Select","Select",""],["","65162027210","SMZ\/TMP DS","TAB 800-160","14","Select","Select",""],["","60432026415","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","00093220301","METOCLOPRAM","TAB 10MG","40","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":""}]}]}