{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"GINA CASTILLO","gend":1,"add":"200 PITCHKETTLE RD RM 134","city":"SUFFOLK","state":"VA","zip":"23434-9998","dob":"1988-06-24","age":"","mstatus":"","insh":"1383524*01","cliId":"","pno":"757\/288-0398","cno":"757\/288-0398","email":"","ename":"","eno":"","pphy":"RUBINO, MARY C MD","ppno":"757\/446-5955","pcpadd":"825 FAIRFAX AVE STE 118","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23507,"pcpcounty":"","pcpid":100070,"pcpname":"EVMS Ghent Family Medicine","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/446-5196","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E11.42","Z79.4","E11.65","S99.922A","Z30.9","M79.662","M79.89","R07.89","S91.312A","M79.672","E10.40","R60.9","M25.562","F41.9","F32.9","R80.9","Z23.","R07.9","I10.","R51.9"],"date":["2020-08-31","2020-04-23","2021-06-04","2020-07-02","2020-07-02","2021-06-04","2021-06-04","2021-06-04","2020-07-08","2020-07-08","2020-07-08","2021-06-04","2020-11-17","2020-10-21","2020-10-21","2020-03-20","2020-06-12","2021-06-04","2021-04-01","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":[["","68645052254","SERTRALINE ","50MG","30","Select","Select",""],["","53885024510","ONETOUCH ","ULTRA BL","300","Select","Select",""],["","56151146001","TRUE ","GLUCOSE","300","Select","Select",""],["","00002871501","HUMULIN ","70\/30","30","Select","Select",""],["","00088221905","LANTUS ","100\/ML","15","Select","Select",""],["","00169183702","NOVOLIN70\/30 ","RELION","30","Select","Select",""],["","68645055254","LISINOPRIL ","10MG","90","Select","Select",""],["","00904404073","ASPIRIN ","81MG","36","Select","Select",""],["","70010049101","METFORMIN ","500MG ER","90","Select","Select",""],["","50228018005","GABAPENTIN ","300MG","30","Select","Select",""],["","60505257809","ATORVASTATIN ","10MG","90","Select","Select",""],["","00169183711","NOVOLIN ","70\/30","30","Select","Select",""],["","08290320119","BD  PEN NEEDL","31GX5MM","100","Select","Select",""],["","67877032105","IBUPROFEN ","800MG","14","Select","Select",""],["","13668001101","CITALOPRAM ","40MG","60","Select","Select",""],["","31722072320","LEVOFLOXACIN ","750MG","7","Select","Select",""],["","08290328431","INSULIN ","0.3\/30G","100","Select","Select",""],["","68462010340","FLUCONAZOLE ","150MG","2","Select","Select",""],["","57237001830","DULOXETINE ","30MG","60","Select","Select",""],["","63304069301","CLINDAMYCIN ","300MG","21","Select","Select",""],["","66993001968","ALBUTEROL ","HFA","18","Select","Select",""],["","08290320119","BD PEN NEEDL","31GX5MM","100","Select","Select",""],["","00904404073","ASPIRIN","81MG","30","Select","Select",""],["","00002871501","HUMULIN","70\/30","10","Select","Select",""],["","68645052254","SERTRALINE","50MG","30","Select","Select",""],["","53885024510","ONETOUCH","ULTRA BL","300","Select","Select",""],["","56151146001","TRUE","GLUCOSE","300","Select","Select",""],["","00169183702","NOVOLIN70\/30","RELION","30","Select","Select",""],["","68645055254","LISINOPRIL","10MG","90","Select","Select",""],["","70010049101","METFORMIN","500MG ER","30","Select","Select",""],["","69097081307","GABAPENTIN","100MG","30","Select","Select",""],["","00169183711","NOVOLIN","70\/30","30","Select","Select",""],["","60505257809","ATORVASTATIN","10MG","90","Select","Select",""],["","57237001830","DULOXETINE","30MG","60","Select","Select",""],["","00088221905","LANTUS","100\/ML","15","Select","Select",""],["","63304069301","CLINDAMYCIN","300MG","21","Select","Select",""],["","08290328431","INSULIN","0.3\/30G","100","Select","Select",""],["","68462010340","FLUCONAZOLE","150MG","2","Select","Select",""],["","66993001968","ALBUTEROL","HFA","18","Select","Select",""],["","13668001001","CITALOPRAM","20MG","90","Select","Select",""],["","67877032105","IBUPROFEN","800MG","14","Select","Select",""],["","31722072320","LEVOFLOXACIN","750MG","7","Select","Select",""],["","00378456177","POT  CHLORIDE","TAB 10MEQ ER","30","Select","Select",""],["","11822365670","ACETAMIN ","TAB 500MG","30","Select","Select",""],["","69238148901","BUMETANIDE ","TAB 0.5MG","30","Select","Select",""],["","57237002801","AMOXICILLIN ","TAB 500MG","21","Select","Select",""],["","50742026001","NIFEDIPINE ","TAB 30MG ER","30","Select","Select",""],["","31722070190","LOSARTAN ","TAB 50MG","30","Select","Select",""],["","00406051201","OXYCOD\/APAP ","TAB 5-325MG","15","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","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Yes","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":""}]}]}