{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"OH HAYIKANSIRRAG-KO","gend":1,"add":"OTLLIH 783D TPA RD P","city":"NEWPORT NEWS","state":"VA","zip":"23603-9998","dob":"2001-08-20","age":"","mstatus":"","insh":"76600210*32","cliId":"","pno":"76\/7623809-0","cno":"267\/670-9083","email":"","ename":"","eno":"","pphy":"WASHINGTON, KAREN MD","ppno":"757\/874-8400","pcpadd":"15425-H WARWICK BLVD","pcpcity":"NEWPORT NEWS","pcpstate":"VA","pcpzip":23607,"pcpcounty":"","pcpid":"","pcpname":"Fort Norfolk Plaza Primary Care","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":["H90.5","H91.93","R05.","J30.2","J30.1","J30.81","J30.89","R51.9","R09.82","J02.9","J45.909","L50.9","J30.9","K59.00","R10.9","R09.81","J35.1","J34.3","J34.2","R82.90","L74.8","J45.20","Z01.82","H90.3","R05.9","R94.02","G43.009","H90.8","K21.9","F41.0","R06.00","Z13.0","R62.50","Z23.","F32.9","H91.90","F41.9","Z13.89","N76.0","J30.5","L50.0","R35.0","N30.00"],"date":["2021-07-08","2021-01-07","2021-07-08","2022-01-21","2022-01-21","2022-01-21","2022-01-19","2021-09-23","2022-01-21","2021-01-07","2022-01-21","2022-01-21","2022-01-14","2021-01-25","2021-01-25","2021-10-12","2021-10-12","2022-01-21","2022-01-21","2022-02-22","2022-02-22","2022-02-22","2020-11-11","2021-10-12","2021-10-12","2021-03-03","2021-03-03","2022-01-21","2022-01-21","2022-01-21","2022-01-21","2020-09-22","2020-09-22","2021-09-23","2020-09-22","2020-09-22","2022-01-26","2022-01-26","2022-04-24","2020-11-17","2020-11-17","2021-12-26","2021-12-26"],"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":[]},{"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":[["","45802065078","LORATADINE","TAB 10MG","30","Select","Select",""],["","00173068220","VENTOLIN","AER ","18","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","8","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","59651000305","OMEPRAZOLE","CAP 40MG","30","Select","Select",""],["","65862057490","MONTELUKAST","TAB 10MG","30","Select","Select",""],["","55111029336","SUMATRIPTAN","TAB 100MG","9","Select","Select",""],["","70710122501","AMITRIPTYLIN","TAB 10MG","60","Select","Select",""],["","00093356026","PEG\/NASUL,C","SOL NACL\/POT","1","Select","Select",""],["","11822353540","RA","POW ","510","Select","Select",""],["","59779030604","CVS","POW ","850","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","6","Select","Select",""],["","00115169449","EPINEPHRINE","INJ 0.3MG","2","Select","Select",""],["","11534018701","BUT\/APAP\/CAF","CAP ","30","Select","Select",""],["","59746000103","METHYLPRED","TAB 4MG","21","Select","Select",""],["","50383066730","LIDO\/PRILOCN","CRE 2.5-2.5%","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":""}]}]}