{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"AMANDA   M GREENE","gend":1,"add":"4308 GRIFFIN ST","city":"PORTSMOUTH","state":"VA","zip":"23707-9998","dob":"2000-04-04","age":"","mstatus":"","insh":"1907988*01","cliId":"","pno":"757\/399-6503","cno":"757\/399-6503","email":"","ename":"","eno":"","pphy":"RAMOLIA, MANSUKHLAL R MD","ppno":"757\/483-6401","pcpadd":"4035 TAYLOR RD #K","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":23321,"pcpcounty":"","pcpid":210204,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/686-3025","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["O24.410","H52.01","H52.12","H52.223","F33.1","Z20.828","Z39.1","Z13.32","O99.214","F32.9","S93.401A","R10.84","Z71.9","L24.9","Z30.430","Z32.02","J06.9","Z72.0","E66.01","Z68.43","Z71.89","E03.9","F17.200","R30.0","E55.9","J30.89"],"date":["2020-02-13","2020-02-13","2020-02-13","2020-02-13","2020-02-20","2021-06-08","2020-01-24","2020-01-24","2020-01-24","2020-01-24","2021-04-23","2021-07-02","2021-07-02","2021-04-01","2021-04-26","2021-04-26","2021-06-08","2021-06-08","2020-08-06","2020-08-06","2020-01-08","2021-06-18","2020-07-08","2021-02-22","2021-06-18","2021-06-18"],"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":[["","00904585652","CALCIUM ","600MG","60","Select","Select",""],["","65162046650","IBUPROFEN ","800MG","30","Select","Select",""],["","63044015005","PRENATAL ","LOW IRON","30","Select","Select",""],["","42858010250","OXYCOD\/APAP ","5-325MG","20","Select","Select",""],["","00781286810","OMEPRAZOLE ","20MG DR","30","Select","Select",""],["","00574200830","NYSTOP ","100000","30","Select","Select",""],["","42858004001","HYDROCO\/APAP ","5-300MG","12","Select","Select",""],["","57237001830","DULOXETINE ","30MG","65","Select","Select",""],["","29300011101","LAMOTRIGINE ","25MG","105","Select","Select",""],["","29300013501","CLONIDINE ","0.1MG","30","Select","Select",""],["","42806040021","METHYLPRED ","4MG","21","Select","Select",""],["","49035030882","PAIN ","500MG","21","Select","Select",""],["","00143924920","AMOX\/K ","875-125","20","Select","Select",""],["","00185012201","NITROFURANTN ","100MG","10","Select","Select",""],["","00603533932","PREDNISONE ","20MG","21","Select","Select",""],["","60505082601","IPRATROPIUM ","0.03%","30","Select","Select",""],["","00955100810","ENOXAPARIN ","80\/0.8ML","6","Select","Select",""],["","00904759080","FEROSUL ","325MG","30","Select","Select",""],["","00904645780","DOK ","100MG","30","Select","Select",""],["","00904759080","FEROSUL","325MG","30","Select","Select",""],["","63044015005","PRENATAL","LOW IRON","30","Select","Select",""],["","65162046650","IBUPROFEN","800MG","30","Select","Select",""],["","00955100810","ENOXAPARIN","80\/0.8ML","6","Select","Select",""],["","42858010250","OXYCOD\/APAP","5-325MG","20","Select","Select",""],["","00781286810","OMEPRAZOLE","20MG DR","30","Select","Select",""],["","00904585652","CALCIUM","600MG","60","Select","Select",""],["","00574200830","NYSTOP","100000","30","Select","Select",""],["","42858004001","HYDROCO\/APAP","5-300MG","12","Select","Select",""],["","57237001830","DULOXETINE","30MG","65","Select","Select",""],["","29300013501","CLONIDINE","0.1MG","30","Select","Select",""],["","29300011101","LAMOTRIGINE","25MG","105","Select","Select",""],["","00904645780","DOK","100MG","30","Select","Select",""],["","49035030882","PAIN","500MG","21","Select","Select",""],["","00143924920","AMOX\/K","875-125","20","Select","Select",""],["","00185012201","NITROFURANTN","100MG","10","Select","Select",""],["","00603533932","PREDNISONE","20MG","21","Select","Select",""],["","42806040021","METHYLPRED","4MG","21","Select","Select",""],["","60505082601","IPRATROPIUM","0.03%","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":""}]}]}