{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"  SEROLEDEGAVAS A ","gend":1,"add":"AES 43543DAOR EDIS","city":"PAINTER","state":"VA","zip":"23420-9998","dob":"1959-03-09","age":"","mstatus":"","insh":"58500210*02","cliId":"","pno":"07\/7575171-9","cno":"","email":"","ename":"","eno":"","pphy":"WASHBURN, KELLY MD","ppno":"757\/331-1086","pcpadd":"17068 LANKFORD HWY","pcpcity":"EASTVILLE","pcpstate":"VA","pcpzip":23347,"pcpcounty":"","pcpid":"","pcpname":"EASTERN SHORE RURAL HEALTH SYSTEM INC","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","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":["R26.2","M25.60","M25.50","R07.9","S70.912A","R27.9","M19.012","I10.","M54.31","I69.351","J41.0","E66.3","Z68.25","F32.9","L98.9","E78.5","F17.210","Z23.","E55.9","Z12.11","S63.105A","S32.509A","S30.1XXA","S37.20XA","V54.13","V58.89","M54.16","Z91.81","J44.9","S32.599A","M79.643","M54.9","S32.511A","N94.89","T14.90XA","S32.501A","M25.512","M25.651","M25.551","R94.2","M20.21","M19.019","M75.42","S32.591A","R40.2410","Z20.828","S39.82XA","S32.89XA","S69.90XA","Z87.81","M79.604","M79.671","R27.0","Z86.73","M47.816","R29.6","R94.31","G89.29","M20.41","M54.5","Z11.59","N32.81","N39.41","M19.041","M19.042","NO DATA","M62.81","Z00.00","F33.3","Z12.31","R26.81","Z68.23","R41.0"],"date":["2022-06-03","2019-10-11","2019-10-11","2020-10-02","2020-09-30","2020-09-30","2021-09-01","2022-10-26","2020-03-09","2019-08-07","2019-08-07","2020-10-21","2020-10-21","2021-10-28","2019-10-23","2022-04-04","2022-10-26","2022-10-26","2022-04-04","2022-10-26","2020-09-30","2020-09-30","2020-09-30","2020-09-30","2020-10-05","2020-10-05","2022-06-22","2020-10-05","2022-10-26","2020-09-30","2020-09-30","2020-09-30","2020-10-02","2020-10-02","2020-10-02","2020-10-02","2020-12-09","2021-01-12","2022-06-03","2021-03-03","2021-08-23","2020-09-02","2020-09-02","2020-09-30","2020-09-30","2020-09-30","2020-09-30","2020-09-30","2020-09-30","2020-12-11","2019-11-13","2019-11-13","2019-11-13","2019-11-13","2020-05-28","2020-08-18","2020-10-02","2020-12-09","2021-04-09","2021-08-12","2019-06-20","2022-09-27","2022-09-27","2022-02-24","2022-02-24","2022-06-03","2022-06-03","2022-04-04","2022-10-26","2022-04-04","2022-04-04","2022-04-04","2022-10-26"],"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":[["","68180052002","LISINOP\/HCTZ","TAB 20-25MG","90","Select","Select",""],["","42806054701","VITAMIN","CAP 1.25MG","4","Select","Select",""],["","16729031816","OXYBUTYNIN","TAB 10MG ER","30","Select","Select",""],["","72205002590","ATORVASTATIN","TAB 80MG","30","Select","Select",""],["","16714066202","GABAPENTIN","CAP 300MG","90","Select","Select",""],["","68462039730","OMEPRAZOLE","CAP 40MG","30","Select","Select",""],["","65862069705","VENLAFAXINE","CAP 150MG ER","90","Select","Select",""],["","70377000415","SIMVASTATIN","TAB 40MG","90","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","00527293341","PREDNISONE","TAB 10MG","42","Select","Select",""],["","69097084507","CYCLOBENZAPR","TAB 5MG","30","Select","Select",""],["","00186037220","SYMBICORT","AER 80-4.5","10","Select","Select",""],["","45802006436","TRIAMCINOLON","CRE 0.001","80","Select","Select",""],["","70677003101","SM","DIS 14MG\/24H","28","Select","Select",""],["","00067815202","VOLTAREN","GEL 0.01","50","Select","Select",""],["","69547035302","NARCAN","SPR ","2","Select","Select",""],["","50383027201","DICLOFENAC","GEL 0.01","100","Select","Select",""],["","00254100752","ALBUTEROL","AER HFA","7","Select","Select",""],["","00085113204","PROVENTIL","AER HFA","7","Select","Select",""],["","10702001850","OXYCODONE","TAB 5MG","20","Select","Select",""],["","00904673080","ACETAMIN","TAB 500MG","90","Select","Select",""],["","24689078501","BUSPIRONE","TAB 7.5MG","60","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":""}]}]}