{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" HENRY KELLEY JR JR","gend":0,"add":"3092 N RIVERSIDE DR","city":"LANEXA","state":"VA","zip":"23089-9998","dob":"1963-04-04","age":"","mstatus":"","insh":"2016814*01","cliId":"","pno":"757\/566-0321","cno":"757\/566-0321, ","email":"","ename":"","eno":"","pphy":"HARRISON, JARED S DO","ppno":"757\/345-0011","pcpadd":"7364 RICHMOND ROAD","pcpcity":"WILLIAMSBURG","pcpstate":"VA","pcpzip":"23188-9998","pcpcounty":"","pcpid":118380,"pcpname":"Riverside Primary Care Norge","plan":"OHP - OPTIMA","program":"ACA","lob":"Individual","region":"CENTRAL","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":["R94.5","H18.12","Q13.2","I10.","L40.9","Q80.9","L81.2","D69.2","L82.1","D22.70","D22.5","D22.60","L81.4","L57.8","I78.1","Z12.83","H53.141","H04.123","H52.203","H52.4","H43.89","Z96.89","K76.0","R16.0","F10.10","E66.9","L40.52","Z87.891","I49.9","R09.81","L40.59","L40.8","R79.89","Z71.89","Z79.899","H93.293","Z12.5","E78.2","E66.01","L40.50","E55.9","R06.81","Z11.59","Z11.1","Z01.818","Z12.11","H21.562","R42.","H81.4","R51.9","H61.21","J34.2","E03.9","H01.02A","H01.02B","L72.0","I95.1","Z23.","H33.052","G47.33","R06.83","K70.30","Z20.822","H18.11","H17.89","H33.012","H57.12","S05.92XA","T85.22XA","Z00.00","A60.00","Z72.89"],"date":["2020-11-02","2020-10-08","2020-10-08","2021-04-29","2020-12-21","2020-12-21","2020-12-21","2020-12-21","2020-12-21","2020-12-21","2020-12-21","2020-12-21","2020-12-21","2020-12-21","2020-12-21","2020-12-21","2021-04-15","2021-04-15","2021-04-15","2021-04-15","2020-01-07","2020-01-07","2020-11-02","2020-07-02","2020-11-02","2021-04-21","2020-08-05","2020-11-02","2020-11-06","2020-11-06","2021-04-13","2021-04-12","2021-04-12","2020-12-30","2021-04-12","2021-02-17","2020-02-20","2020-10-30","2020-08-13","2021-01-26","2021-04-12","2021-03-16","2021-04-12","2021-04-12","2020-10-30","2020-10-30","2020-10-08","2021-02-17","2021-03-23","2021-02-17","2021-02-17","2021-02-17","2021-04-29","2020-06-22","2020-06-22","2020-10-23","2020-10-23","2020-10-23","2020-11-04","2021-03-23","2021-03-23","2021-04-29","2021-01-26","2021-02-17","2020-11-04","2020-11-04","2020-11-04","2020-11-04","2020-11-04","2020-10-30","2020-12-22","2021-04-21"],"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":[["","00781723864","BUPREN\/NALOX","8-2MG","15","Select","Select",""],["","45802006436","TRIAMCINOLON","0.10%","80","Select","Select",""],["","61314063705","PREDNISOLONE","1% OP","5","Select","Select",""],["","60505056000","OFLOXACIN","0.3% OP","5","Select","Select",""],["","65162036111","FOLIC","1MG","30","Select","Select",""],["","68180051801","LISINOP\/HCTZ","10-12.5","30","Select","Select",""],["","00074055402","HUMIRA","40\/0.4ML","-2","Select","Select",""],["","51672129303","CLOBETASOL","0.05%","50","Select","Select",""],["","12496120803","SUBOXONE","8-2MG","15","Select","Select",""],["","61314001405","DICLOFENAC","0.1% OP","5","Select","Select",""],["","68180098003","LISINOPRIL","10MG","90","Select","Select",""],["","55513013760","OTEZLA","30MG","-60","Select","Select",""],["","50383023310","DORZOL\/TIMOL","22.3-6.8","10","Select","Select",""],["","0","","","30","Select","Select",""],["","00378180010","LEVOTHYROXIN","25MCG","90","Select","Select",""],["","53489011905","DOXYCYCL","100MG","20","Select","Select",""],["","00093310905","AMOXICILLIN","500MG","23","Select","Select",""],["","80777027399","MODERNA","COVID-19","0","Select","Select",""],["","60505100301","KETOROLAC","0.50%","5","Select","Select",""],["","65162070294","FLUOCIN","0.01%","20","Select","Select",""],["","00065064835","TOBRADEX","0.3-0.1%","4","Select","Select",""],["","31722070530","VALACYCLOVIR","1GM","5","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":[[["No","Select","","","","","Select","",""],["No","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":""}]}]}