{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"  ARAIKLLEB D ","gend":1,"add":"LLEHS 3122B3 TPA DR ","city":"HAMPTON","state":"VA","zip":"23661-9998","dob":"1991-09-04","age":"","mstatus":"","insh":"6603110*22","cliId":"","pno":"09\/7572484-7","cno":"","email":"","ename":"","eno":"","pphy":"DELAHOUSSAYE, ALADEE R MD","ppno":"757\/380-8709","pcpadd":"4714 MARSHALL AVE","pcpcity":"NEWPORT NEWS","pcpstate":"VA","pcpzip":23607,"pcpcounty":"","pcpid":"","pcpname":"PENINSULA INSTITUTE FOR COMMUNITY HEALTH","plan":"OHP","program":"MEDICAID","lob":"M4","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":["F33.9","F41.9","J20.9","R06.03","M79.601","Z32.02","G43.109","K00.4","R10.30","N92.6","F43.0","K59.00","A09.","M25.511","S39.012A","S70.361A","W57.XXXA","K08.89","Z88.0","F11.20","Z71.51","F41.1","F15.20","N30.01","G43.011","K02.9","H69.83","G47.33","R53.82","G47.9","R06.83","H65.93","K08.9","G89.29","K04.7","Z87.891","S99.922A","S93.601A"],"date":["2021-09-27","2021-12-03","2020-03-09","2020-03-09","2020-11-20","2020-11-20","2020-12-05","2020-12-05","2020-02-21","2020-02-21","2020-02-21","2021-03-19","2021-03-19","2020-11-23","2020-06-28","2020-10-07","2020-10-07","2020-01-04","2020-01-04","2019-01-07","2019-01-07","2019-01-07","2019-01-07","2019-04-19","2019-08-03","2019-12-30","2019-01-07","2019-01-23","2019-01-07","2019-01-07","2019-01-07","2019-01-07","2019-07-27","2019-07-27","2019-07-27","2019-07-27","2019-06-19","2019-06-19"],"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":[["","00591530710","PROMETHAZINE","TAB 25MG","12","Select","Select",""],["","","KETOROLAC","TAB 10MG","","Select","Select",""],["","","ALBUTEROL","AER HFA","","Select","Select",""],["","","PROAIR","AER ","","Select","Select",""],["","","FLOVENT","AER 220MCG","","Select","Select",""],["","","MUPIROCIN","OIN 0.02","","Select","Select",""],["","","MELOXICAM","TAB 15MG","","Select","Select",""],["","","DOXYCYC","CAP 100MG","","Select","Select",""],["","50383077504","LIDOCAINE","SOL 2% VISC","100","Select","Select",""],["","65862018601","CLINDAMYCIN","CAP 300MG","28","Select","Select",""],["","","CIPROFLOXACN","TAB 500MG","","Select","Select",""],["","","PREDNISONE","TAB 20MG","","Select","Select",""],["","","MUCINEX","TAB 600MG ER","","Select","Select",""],["","","FLUCONAZOLE","TAB 150MG","","Select","Select",""],["","","AZITHROMYCIN","TAB 250MG","","Select","Select",""],["","","CYCLOBENZAPR","TAB 5MG","","Select","Select",""],["","00406012305","HYDROCO\/APAP","TAB 5-325MG","4","Select","Select",""],["","","VENTOLIN","AER ","","Select","Select",""],["","","BUT\/ASA\/CAFF","CAP ","","Select","Select",""],["","60505082901","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","59746000103","METHYLPRED","TAB 4MG","21","Select","Select",""],["","51293081101","PHENAZOPYRID","TAB 200MG","6","Select","Select",""],["","65862001905","CEPHALEXIN","CAP 500MG","14","Select","Select",""],["","11917011404","TOOTHACHE","GEL PAIN REL","9","Select","Select",""],["","00527193206","CLARITHROMYC","TAB 500MG","20","Select","Select",""],["","10310028313","ORAJEL","GEL 0.2","9","Select","Select",""],["","00283029331","HURRICAINE","GEL 0.2","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":""}]}]}