{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"D YORLAVU","gend":0,"add":"NISSORC 49453 TPA TC G","city":"NEWPORT NEWS","state":"VA","zip":"23608-9998","dob":"1969-03-10","age":"","mstatus":"","insh":"96500210*93","cliId":"","pno":"04\/7574168-5","cno":"757\/405-8614","email":"","ename":"","eno":"","pphy":"GORDON, ASIA D NP","ppno":"757\/930-0091","pcpadd":"12715 WARWICK BLVD SUITE O","pcpcity":"NEWPORT NEWS","pcpstate":"VA","pcpzip":23606,"pcpcounty":"","pcpid":"","pcpname":"Commonwealth Family Practice","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":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z09.","F17.210","Z87.448","J44.9","M25.50","I10.","K42.9","R07.9","R31.0","R10.31","N12.","R09.02","J44.1","F10.239","N20.0","Z79.82","F17.200","F12.90","K59.00","R31.9","Z00.00","L98.9","N39.0","J96.21","R25.1","Z79.51","J30.2","K04.7"],"date":["2020-05-27","2021-09-16","2020-05-27","2020-05-27","2020-05-27","2021-09-16","2020-08-20","2020-02-06","2020-02-08","2020-02-10","2020-02-08","2020-02-08","2021-06-11","2020-02-06","2020-02-11","2020-02-06","2020-02-06","2020-02-06","2020-02-06","2020-02-06","2021-04-20","2021-04-20","2020-02-11","2020-02-10","2020-02-11","2021-06-11","2021-06-11","2021-09-16"],"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":[["","59310057922","PROAIR","AER ","8","Select","Select",""],["","00228277911","PROPRANOLOL","CAP 80MG ER","30","Select","Select",""],["","00186037220","SYMBICORT","AER 80-4.5","10","Select","Select",""],["","00597007541","SPIRIVA","CAP HANDIHLR","30","Select","Select",""],["","29300046810","CLONIDINE","TAB 0.1MG","90","Select","Select",""],["","00310737020","BUDES\/FORMOT","AER 160-4.5","31","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","8","Select","Select",""],["","68382013201","TAMSULOSIN","CAP 0.4MG","30","Select","Select",""],["","00406051205","OXYCOD\/APAP","TAB 5-325MG","12","Select","Select",""],["","57237007710","ONDANSETRON","TAB 4MG ODT","20","Select","Select",""],["","16571020150","DICLOFENAC","TAB 75MG DR","180","Select","Select",""],["","27241009803","DULOXETINE","CAP 30MG","30","Select","Select",""],["","59746017506","PREDNISONE","TAB 20MG","3","Select","Select",""],["","29300012810","HYDROCHLOROT","TAB 25MG","90","Select","Select",""],["","65862020399","LOSARTAN","TAB 100MG","90","Select","Select",""],["","00143993905","AMOXICILLIN","CAP 500MG","20","Select","Select",""],["","00093031401","KETOROLAC","TAB 10MG","20","Select","Select",""],["","00172572860","FAMOTIDINE","TAB 20MG","60","Select","Select",""],["","68180072003","AMLODIPINE","TAB 5MG","30","Select","Select",""],["","00173068220","VENTOLIN","AER ","18","Select","Select",""],["","53746010901","HYDROCO\/APAP","TAB 5-325MG","30","Select","Select",""],["","76204060060","IPRATROPIUM\/","SOL ALBUTER","180","Select","Select",""],["","68180098103","LISINOPRIL","TAB 20MG","30","Select","Select",""],["","55111028050","LEVOFLOXACIN","TAB 500MG","2","Select","Select",""],["","64380080807","IBUPROFEN","TAB 600MG","60","Select","Select",""],["","11917004918","ACETAMIN","TAB 500MG","60","Select","Select",""],["","00406055201","OXYCODONE","TAB 5MG","15","Select","Select",""],["","43598044674","NICOTINE","DIS 7MG\/24HR","28","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":""}]}]}