{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TIYANNI CARMICHAEL","gend":1,"add":"7727 CROAKER ROAD APT 101","city":"WILLIAMSBURG","state":"VA","zip":"23188-9998","dob":"2001-10-19","age":"","mstatus":"","insh":"2041851*01","cliId":"","pno":"804\/210-9274","cno":"804\/210-9274","email":"","ename":"","eno":"","pphy":"HARRISON, JARED S DO","ppno":"757\/345-0011","pcpadd":"7364 RICHMOND ROAD","pcpcity":"WILLIAMSBURG","pcpstate":"VA","pcpzip":23188,"pcpcounty":"","pcpid":118380,"pcpname":"Riverside Primary Care Norge","plan":"OHP","program":"ACA","lob":"Individual","region":"TIDEWATER","aligned":"","ano":"804\/210-9274","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":["G80.0","M62.838","R26.1","M24.572","M24.532","M24.531","G80.9","P91.60","J45.20","K21.9","R63.5","R63.3","Z93.1","T81.31XA","R62.7","K59.04","K59.00","N39.0","R10.84","K59.01","F80.2","Z23.","N94.89","G93.49","G40.301","J18.9","G40.219","Q02.","F72.","B37.0","R10.9","G40.909","R10.33","R74.8","Z46.89","L20.84","L81.0","N31.9","M24.562","M24.571","M24.561","F80.1","R14.0","K92.0","K59.09","B96.4","G93.1","G80.8","R45.1","Z16.39","J30.2","R21.","Z20.822","Z79.899","Z46.59","M24.512","R70.0"],"date":["2021-11-08","2021-11-08","2021-10-14","2020-06-11","2020-03-02","2020-03-02","2021-10-16","2021-06-29","2021-06-29","2021-10-15","2021-02-08","2020-12-21","2021-10-15","2021-10-16","2021-10-16","2021-04-14","2021-06-06","2021-05-30","2021-05-25","2021-10-15","2021-02-11","2021-03-25","2020-03-16","2021-11-08","2021-05-30","2020-03-10","2021-11-08","2020-04-22","2021-11-08","2021-05-29","2021-06-08","2021-05-29","2021-06-08","2021-06-08","2020-06-09","2020-10-19","2020-10-19","2021-06-10","2020-06-09","2020-06-09","2020-06-09","2020-06-09","2021-06-08","2021-06-06","2021-05-29","2021-05-29","2021-05-29","2021-05-29","2021-05-29","2021-05-29","2021-05-29","2021-05-29","2021-05-29","2021-05-29","2021-06-06","2021-10-14","2021-10-15"],"priorHcc":[null,null,null,"","","",null,"","",null,"","",null,null,null,"","","","",null,"","","",null,"","",null,"",null,"","","","","","","","","","","","","","","","","","","","","","","","","","",null,null]}},{"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":[["","45802086803","POLYETH","3350 NF","510","Select","Select",""],["","65628008003","LANSOPRAZOLE","3MG\/ML","-630","Select","Select",""],["","16729042212","TACROLIMUS","0.10%","-60","Select","Select",""],["","00536126659","SENNA","8.8\/5ML","150","Select","Select",""],["","69367021201","PHENOBARB","32.4MG","30","Select","Select",""],["","65862042005","SMZ\/TMP","800-160","14","Select","Select",""],["","47781030801","NITROFUR","100MG","-28","Select","Select",""],["","60432053760","NYSTATIN","100000","-280","Select","Select",""],["","16571074024","NITROFURANTN","25MG\/5ML","280","Select","Select",""],["","00168000615","TRIAMCINOLON","0.10%","60","Select","Select",""],["","00143988901","AMOXICILLIN","250\/5ML","200","Select","Select",""],["","45802086803","POLYETH ","3350 NF","510","Select","Select",""],["","57896045208","SENNA ","8.8MG\/5","150","Select","Select",""],["","00603516621","PHENOBARB ","32.4MG","30","Select","Select",""],["","65628008003","LANSOPRAZOLE ","3MG\/ML","630","Select","Select",""],["","00168000615","TRIAMCINOLON ","0.10%","60","Select","Select",""],["","16729042212","TACROLIMUS ","0.10%","-60","Select","Select",""],["","16571074024","NITROFURANTN ","25MG\/5ML","280","Select","Select",""],["","00143988901","AMOXICILLIN ","250\/5ML","200","Select","Select",""],["","60432053760","NYSTATIN ","100000","-280","Select","Select",""],["","65862042005","SMZ\/TMP ","800-160","14","Select","Select",""],["","47781030801","NITROFUR ","100MG","28","Select","Select",""],["","00054318863","DIAZEPAM ","5MG\/5ML","-180","Select","Select",""],["","00054318863","DIAZEPAM","5MG\/5ML","-180","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","",""],["No","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":""}]}]}