{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KEISHA  L BOONE","gend":1,"add":"9567 16TH BAY ST APT 3","city":"NORFOLK","state":"VA","zip":"23518-9998","dob":"1980-06-24","age":"","mstatus":"","insh":"1428905*01","cliId":"","pno":"757\/635-5384","cno":"757\/635-5384","email":"","ename":"","eno":"","pphy":"KAPUR, ANAND MD","ppno":"757\/673-5890","pcpadd":"SUITE 250 5818 HARBOUR VIEW BLV","pcpcity":"SUFFOLK","pcpstate":"VA","pcpzip":23435,"pcpcounty":"","pcpid":131856,"pcpname":"HARBOUR VIEW FAMILY PRACTICE","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/673-5946","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J06.9","F31.5","I10.","F31.64","L03.818","M25.552","G89.29","M25.50","Z96.641","F31.9","M54.5","Z00.00","Z12.31","Z68.37","M25.561","M25.562","K57.32","R10.31","R19.8","D72.829","K57.92","K63.0","I42.9","F14.10","L02.91"],"date":["2020-03-09","2020-08-11","2021-08-03","2020-02-07","2020-07-09","2021-04-02","2021-04-02","2021-04-02","2021-04-02","2021-04-02","2021-04-02","2021-04-02","2021-04-02","2021-04-02","2021-04-13","2021-04-13","2021-08-05","2021-08-03","2021-08-05","2021-08-03","2021-08-05","2021-08-03","2021-08-03","2021-08-05","2021-08-04"],"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":[["","67877019705","AMLODIPINE ","2.5MG","30","Select","Select",""],["","68382009505","CARVEDILOL ","25MG","60","Select","Select",""],["","62756018488","OXCARBAZEPIN ","300MG","45","Select","Select",""],["","69543025216","VIRTUSSIN ","100-10\/5","60","Select","Select",""],["","50111078751","AZITHROMYCIN ","250MG","6","Select","Select",""],["","31722070290","LOSARTAN ","100MG","30","Select","Select",""],["","68645056259","IBUPROFEN ","600MG","30","Select","Select",""],["","00591352530","LIDOCAINE ","5%","15","Select","Select",""],["","42858010201","OXYCOD\/APAP ","5-325MG","6","Select","Select",""],["","00143924920","AMOX\/K ","875-125","20","Select","Select",""],["","16714008210","HYDROXYZ ","25MG","120","Select","Select",""],["","16571020210","DICLOFENAC ","50MG DR","30","Select","Select",""],["","13668021730","ARIPIPRAZOLE ","5MG","30","Select","Select",""],["","68645052354","SERTRALINE ","100MG","30","Select","Select",""],["","00781261305","AMOXICILLIN ","500MG","30","Select","Select",""],["","65862053820","LEVOFLOXACIN ","750MG","10","Select","Select",""],["","50111033402","METRONIDAZOL ","500MG","30","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","",""],["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":""}]}]}