{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LORETTA WILTON","gend":1,"add":"3410 WINTERHAWK CT","city":"CHESAPEAKE","state":"VA","zip":"23323-9998","dob":"1977-05-22","age":"","mstatus":"","insh":"1836081*01","cliId":"","pno":"757\/567-5113","cno":"757\/567-5113","email":"","ename":"","eno":"","pphy":"KAPOOR, SONIA MD","ppno":"757\/548-0076","pcpadd":"SUITE 100 725 VOLVO PKWY","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":23320,"pcpcounty":"","pcpid":134965,"pcpname":"Family Physicians of Chesapeake","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/548-4652","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F41.1","F90.0","I10.","E11.9","E78.00","G95.0","M54.16","G89.29","M54.5","R10.33","K76.0","D53.9","Z51.81","Z79.891","F32.1","F84.0","M54.2","M54.6"],"date":["2020-02-07","2020-02-07","2020-01-07","2020-01-07","2020-01-07","2020-05-11","2021-07-01","2021-07-01","2021-07-01","2020-09-01","2020-09-01","2020-09-01","2021-01-04","2021-01-04","2020-01-03","2020-01-03","2021-01-04","2021-01-04"],"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":[["","54092038701","ADDERALL ","20MG","30","Select","Select",""],["","57664037718","TRAMADOL ","50MG","120","Select","Select",""],["","43975033410","AMPHET\/DEXTR ","20MG ER","30","Select","Select",""],["","68382018105","BUSPIRONE ","10MG","30","Select","Select",""],["","49884061153","TIZANIDINE ","2MG","60","Select","Select",""],["","50228018005","GABAPENTIN ","300MG","120","Select","Select",""],["","68001033408","LISINOPRIL ","10MG","30","Select","Select",""],["","00378161005","DICYCLOMINE ","10MG","40","Select","Select",""],["","24385038571","ACID ","20MG","20","Select","Select",""],["","59762040105","SUCRALFATE ","1GM","40","Select","Select",""],["","54092038701","ADDERALL","20MG","30","Select","Select",""],["","57664037718","TRAMADOL","50MG","120","Select","Select",""],["","43975033410","AMPHET\/DEXTR","20MG ER","30","Select","Select",""],["","68382018105","BUSPIRONE","10MG","30","Select","Select",""],["","49884061153","TIZANIDINE","2MG","60","Select","Select",""],["","68001033408","LISINOPRIL","10MG","30","Select","Select",""],["","50228018005","GABAPENTIN","300MG","120","Select","Select",""],["","24385038571","ACID","20MG","20","Select","Select",""],["","59762040105","SUCRALFATE","1GM","40","Select","Select",""],["","00378161005","DICYCLOMINE","10MG","40","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":""}]}]}