{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SHIRLEY ROGERS","gend":1,"add":"2782 BUTTERNUT DR","city":"HAMPTON","state":"VA","zip":"23666-9998","dob":"1960-04-23","age":"","mstatus":"","insh":"1311402*01","cliId":"","pno":"757\/768-4086","cno":"757\/768-4086","email":"","ename":"","eno":"","pphy":"DOWLING, NEQUITA A MD","ppno":"757\/827-1940","pcpadd":"2148 WEST MERCURY BOULEVARD","pcpcity":"HAMPTON","pcpstate":"VA","pcpzip":23666,"pcpcounty":"","pcpid":118380,"pcpname":"Riverside Medical Care Center - Mercury West","plan":"OHP","program":"ACA","lob":"Individual","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":["D12.0","D12.2","D12.3","K29.50","I49.1","I10.","E03.9","E78.00","E11.9","I47.1","R06.09","D50.9","I48.91","K22.0","R94.31","D64.9","Z12.31","R00.2","H40.033","H40.053","K21.9","Z86.010","Z79.899","Z79.4","Z88.0","Z90.710","Z88.8","Z83.71","H40.032","E11.65"],"date":["2020-01-08","2020-01-08","2020-01-08","2020-01-08","2020-01-20","2020-07-31","2020-08-14","2020-01-20","2020-04-29","2020-07-31","2020-07-31","2020-01-06","2020-01-06","2020-01-06","2020-04-29","2020-04-29","2020-12-18","2020-07-13","2020-08-14","2020-08-14","2020-01-06","2020-01-06","2020-01-06","2020-01-06","2020-01-06","2020-01-06","2020-01-06","2020-01-06","2020-12-09","2021-04-01"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}},{"a":[]}]},{"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":[]}]},{"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":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","68645051054","HYDROCHLOROT","25MG","90","Select","Select",""],["","67877048430","TELMISARTAN","80MG","-30","Select","Select",""],["","29300013601","CLONIDINE","0.2MG","30","Select","Select",""],["","00781518492","LEVOTHYROXIN","100MCG","30","Select","Select",""],["","50111032701","HYDRALAZINE","25MG","60","Select","Select",""],["","00093075210","ATENOLOL","50MG","30","Select","Select",""],["","68645058459","METFORMIN","1000MG","60","Select","Select",""],["","68645051554","AMLODIPINE","5MG","30","Select","Select",""],["","29300022019","MONTELUKAST","10MG","-30","Select","Select",""],["","61314054701","LATANOPROST","0.01%","2","Select","Select",""],["","72305010030","EUTHYROX","100MCG","45","Select","Select",""],["","60758011905","PREDNISOLONE","1% OP","5","Select","Select",""],["","67877048430","TELMISARTAN ","80MG","30","Select","Select",""],["","00781518492","LEVOTHYROXIN ","100MCG","30","Select","Select",""],["","29300013601","CLONIDINE ","0.2MG","30","Select","Select",""],["","68645051054","HYDROCHLOROT ","25MG","30","Select","Select",""],["","00093075210","ATENOLOL ","50MG","30","Select","Select",""],["","50111032701","HYDRALAZINE ","25MG","-60","Select","Select",""],["","68645058459","METFORMIN ","1000MG","60","Select","Select",""],["","29300022019","MONTELUKAST ","10MG","30","Select","Select",""],["","68645051554","AMLODIPINE ","5MG","30","Select","Select",""],["","60758011905","PREDNISOLONE ","1% OP","5","Select","Select",""],["","61314054701","LATANOPROST ","0.01%","2","Select","Select",""],["","72305010030","EUTHYROX ","100MCG","45","Select","Select",""],["","00116200116","CHLORHEX ","0.12%","-473","Select","Select",""],["","00116200116","CHLORHEX","0.12%","473","Select","Select",""],["","08290320550","BD PEN NEEDL","32GX5\/32","-100","Select","Select",""],["","00002143380","TRULICITY","0.75\/0.5","2","Select","Select",""],["","00169266015","TRESIBA","100UNIT","15","Select","Select",""],["","00002143380","TRULICITY ","INJ 0.75\/0.5","-2","Select","Select",""],["","08290320550","BD  PEN NEEDL","MIS 32GX5\/32","-100","Select","Select",""],["","00169266015","TRESIBA ","INJ 100UNIT","15","Select","Select",""],["","80777027398","MODERNA ","INJ COVID-19","0","Select","Select",""]]}},{"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":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[[["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""]]]},{"t":"Mini-Cog","q":[{"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":""}]}]}