{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" NNAIDSIVAD","gend":1,"add":" HT41 035A TPA TS","city":"NEWPORT NEWS","state":"VA","zip":"23607-9998","dob":"1965-09-15","age":"","mstatus":"","insh":"26200210*51","cliId":"","pno":"62\/7570738-9","cno":"","email":"","ename":"","eno":"","pphy":"ASPILI, CONCEPCION MD","ppno":"757\/874-8400","pcpadd":"4714 MARSHALL AVE","pcpcity":"NEWPORT NEWS","pcpstate":"VA","pcpzip":23607,"pcpcounty":"","pcpid":"","pcpname":"PENINSULA INSTITUTE FOR COMMUNITY HEALTH","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":7572184798,"add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I10.","B19.20","R12.","J45.909","F10.20","Z12.31","Z28.21","H53.9","F19.10","F32.9","H04.321","H25.13","R10.9","K29.50","R91.1","R11.2","F12.988","R10.84","F14.10","R19.7","K72.00","K83.1","E41.","K76.89","R19.5","B18.2","K92.1","K21.9","H04.411","E43.","F14.20","Z68.1","E78.5","F12.90","F10.10","K57.90","K64.4","Z79.51","Z82.49","Z85.3","B27.09","M54.5","N30.01","M54.9","R10.13","R11.0","K63.9","L03.213","NO DATA","R53.81","F10.288","F12.20","F14.29","R82.5","J44.9","D12.5","G89.29","K44.9","H04.301","S39.82XA","B17.9","H01.009","G47.00"],"date":["2021-01-14","2021-01-14","2021-01-14","2021-01-14","2021-01-14","2021-01-14","2021-01-14","2021-01-14","2021-01-14","2020-06-10","2021-02-16","2021-02-16","2020-04-14","2020-04-14","2020-04-14","2020-04-14","2019-02-04","2019-04-05","2019-02-04","2019-04-05","2019-10-11","2019-10-11","2019-10-11","2019-10-10","2019-03-04","2019-03-04","2019-03-04","2019-10-09","2019-08-28","2019-10-09","2019-10-09","2019-10-09","2019-10-09","2019-10-09","2019-10-09","2019-10-09","2019-10-09","2019-10-09","2019-10-09","2019-10-09","2019-10-11","2019-10-07","2019-04-06","2019-06-05","2019-06-04","2019-10-07","2019-06-04","2019-08-14","2019-08-14","2019-08-14","2019-10-09","2019-10-09","2019-10-09","2019-02-05","2019-02-05","2019-03-04","2019-06-05","2019-04-23","2019-09-19","2019-10-07","2019-10-08","2019-12-09","2019-12-09"],"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":{"indx":[false,false],"comment":["",""],"score":["",""]}},{"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":[["","59310057922","PROAIR","AER ","8","Select","Select",""],["","","TWINRIX","INJ ","","Select","Select",""],["","16714074703","OMEPRAZOLE","CAP 20MG","30","Select","Select",""],["","76204020025","ALBUTEROL","NEB 0.00083","225","Select","Select",""],["","31722072250","LEVOFLOXACIN","TAB 500MG","10","Select","Select",""],["","66685100100","AMOX\/K","TAB 875-125","10","Select","Select",""],["","00173071920","FLOVENT","AER 110MCG","12","Select","Select",""],["","","HYDROCO\/APAP","TAB 5-325MG","","Select","Select",""],["","55111015330","ONDANSETRON","TAB 4MG","30","Select","Select",""],["","60505257809","ATORVASTATIN","TAB 10MG","30","Select","Select",""],["","43547035410","LISINOPRIL","TAB 20MG","30","Select","Select",""],["","67877019805","AMLODIPINE","TAB 5MG","30","Select","Select",""],["","00904615760","VITAMIN","TAB 2000UNIT","30","Select","Select",""],["","50111043301","TRAZODONE","TAB 50MG","30","Select","Select",""],["","","FAMOTIDINE","TAB 20MG","","Select","Select",""],["","","ENGERIX-B","INJ 20MCG\/ML","","Select","Select",""],["","64380076921","PEG-3350\/KCL","SOL \/SODIUM","4000","Select","Select",""],["","00406048410","APAP\/CODEINE","TAB 300-30MG","6","Select","Select",""],["","00591298539","PHENADOZ","SUP 12.5MG","12","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","10","Select","Select",""],["","70010075405","METHOCARBAM","TAB 500MG","40","Select","Select",""],["","69315030805","CIPROFLOXACN","SOL 0.3% OP","5","Select","Select",""],["","65862018601","CLINDAMYCIN","CAP 300MG","15","Select","Select",""],["","68382004101","PROMETHAZINE","TAB 25MG","30","Select","Select",""],["","11822315230","LORATADINE","TAB 10MG","30","Select","Select",""],["","17478007031","ERYTHROMYCIN","OIN OP","10","Select","Select",""],["","00781261305","AMOXICILLIN","CAP 500MG","21","Select","Select",""],["","67877032105","IBUPROFEN","TAB 800MG","12","Select","Select",""],["","55111068301","IBU","TAB 600MG","30","Select","Select",""],["","65162036110","FOLIC","TAB 1MG","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":""}]}]}