{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CHERITA SMITH","gend":1,"add":"1412 LONGDALE DR APT 101","city":"NORFOLK","state":"VA","zip":"23513-9998","dob":"1970-12-19","age":"","mstatus":"","insh":"1744636*01","cliId":"","pno":"757\/738-6200","cno":"757\/738-6200","email":"","ename":"","eno":"","pphy":"DONALDSON, NICOLE MD","ppno":"757\/227-6866","pcpadd":"SUITE 504 301 RIVERVIEW AVENUE","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23510,"pcpcounty":"","pcpid":161071,"pcpname":"Fort Norfolk Plaza Primary Care","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/277-0298","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E55.9","G35.","F33.1","G31.84","R20.2","H53.2","R53.83","T78.1XXA","J31.0","E11.65","Z79.4","R07.89","M62.838","G81.90","I10.","E11.9","Z99.3","Z91.81","Z98.1","Z88.8","Z91.018","M54.2","M54.9","Z20.828","M54.5","R10.84","E87.6","L73.2","H61.22","H25.13"],"date":["2021-08-18","2021-08-18","2021-02-03","2021-08-18","2021-08-18","2021-08-18","2021-08-18","2021-05-26","2021-05-26","2020-11-01","2020-11-01","2020-11-01","2020-03-06","2020-03-06","2020-03-06","2021-07-22","2020-03-06","2020-03-06","2020-03-06","2020-03-06","2020-03-06","2020-03-06","2021-04-27","2020-12-14","2021-04-17","2021-07-22","2021-07-22","2020-08-26","2020-08-26","2020-11-25"],"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":[["","23155000810","HYDROCHLOROT ","25MG","90","Select","Select",""],["","58468021004","AUBAGIO ","14MG","30","Select","Select",""],["","43598029390","PREGABALIN ","75MG","90","Select","Select",""],["","00006027731","JANUVIA ","100MG","30","Select","Select",""],["","60505014101","GLIPIZIDE ","5MG","30","Select","Select",""],["","69452015120","VITAMIN ","50000UNT","4","Select","Select",""],["","50428067309","CVS ","1000UNIT","30","Select","Select",""],["","68180036209","FENOFIBRATE ","54MG","30","Select","Select",""],["","16571020106","DICLOFENAC ","75MG DR","20","Select","Select",""],["","69097086807","NADOLOL ","40MG","90","Select","Select",""],["","65862020390","LOSARTAN ","100MG","30","Select","Select",""],["","00172392670","DIAZEPAM ","5MG","20","Select","Select",""],["","00378064110","PREDNISONE ","10MG","84","Select","Select",""],["","45802086866","POLYETH ","3350 NF","14","Select","Select",""],["","53489011905","DOXYCYCL ","100MG","80","Select","Select",""],["","00245010810","FERROUS ","325MG EC","90","Select","Select",""],["","00088221905","LANTUS ","100\/ML","15","Select","Select",""],["","50428036851","EARWAX ","SYSTEM","15","Select","Select",""],["","59746000103","METHYLPRED ","4MG","21","Select","Select",""],["","08290320119","BD  PEN NEEDL","31GX5MM","100","Select","Select",""],["","51991074690","DULOXETINE ","20MG","30","Select","Select",""],["","11523726803","MIRALAX ","3350 NF","30","Select","Select",""],["","69097094312","GABAPENTIN ","300MG","180","Select","Select",""],["","00093220305","METOCLOPRAM ","10MG","20","Select","Select",""],["","59267100001","PFIZER ","COVID-19","0","Select","Select",""],["","00093720198","PRAVASTATIN ","20MG","30","Select","Select",""],["","55111032101","GLIMEPIRIDE ","2MG","60","Select","Select",""],["","00115169449","EPINEPHRINE ","0.3MG","2","Select","Select",""],["","65862085901","FAMOTIDINE ","20MG","28","Select","Select",""],["","00005197105","PREVNAR ","","0","Select","Select",""],["","65862020390","LOSARTAN","100MG","30","Select","Select",""],["","23155000810","HYDROCHLOROT","25MG","30","Select","Select",""],["","58468021004","AUBAGIO","14MG","30","Select","Select",""],["","43598029390","PREGABALIN","75MG","90","Select","Select",""],["","50428067309","CVS","1000UNIT","30","Select","Select",""],["","00006027731","JANUVIA","100MG","30","Select","Select",""],["","60505014101","GLIPIZIDE","5MG","30","Select","Select",""],["","69452015120","VITAMIN","50000UNT","12","Select","Select",""],["","00172392670","DIAZEPAM","5MG","20","Select","Select",""],["","69097086807","NADOLOL","40MG","12","Select","Select",""],["","00378064110","PREDNISONE","10MG","84","Select","Select",""],["","68180036209","FENOFIBRATE","54MG","30","Select","Select",""],["","45802086866","POLYETH","3350 NF","14","Select","Select",""],["","00245010811","FERROUS","325MG EC","90","Select","Select",""],["","50428036851","EARWAX","SYSTEM","15","Select","Select",""],["","59746000103","METHYLPRED","4MG","21","Select","Select",""],["","00088221905","LANTUS","100\/ML","15","Select","Select",""],["","08290320119","BD PEN NEEDL","31GX5MM","100","Select","Select",""],["","69097094312","GABAPENTIN","300MG","180","Select","Select",""],["","51991074690","DULOXETINE","20MG","30","Select","Select",""],["","59267100001","PFIZER","COVID-19","0","Select","Select",""],["","00115169449","EPINEPHRINE","0.3MG","2","Select","Select",""],["","00093720198","PRAVASTATIN","20MG","30","Select","Select",""],["","55111032101","GLIMEPIRIDE","2MG","60","Select","Select",""],["","11523726803","MIRALAX","3350 NF","30","Select","Select",""],["","65862085901","FAMOTIDINE","20MG","28","Select","Select",""],["","49884068905","METOCLOPRAM","10MG","20","Select","Select",""],["","00005197105","PREVNAR","","0","Select","Select",""],["","00185094097","CHOLESTYRAM","4GM","378","Select","Select",""],["","16571020106","DICLOFENAC","75MG DR","20","Select","Select",""],["","53489011905","DOXYCYCL","100MG","80","Select","Select",""],["","00185094097","CHOLESTYRAM ","POW 4GM","378","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":""}]}]}