{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DELILAH GRAHAM","gend":1,"add":"415 TURLINGTON RD APT 1","city":"NEWPORT NEWS","state":"VA","zip":"23606-9998","dob":"1959-08-24","age":"","mstatus":"","insh":"20028081*01","cliId":"","pno":"757\/534-7865","cno":"757\/534-7865","email":"","ename":"","eno":"","pphy":"ASPILI, CONCEPCION MD","ppno":"757\/874-8400","pcpadd":"4714 MARSHALL AVE","pcpcity":"NEWPORT NEWS","pcpstate":"VA","pcpzip":23607,"pcpcounty":"","pcpid":510019,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"757\/232-7993","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/928-0902","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J98.01","R06.02","M54.41","I10.","S63.502A","S46.912A","E11.9","H04.121","H04.122","H25.11","B35.1","L84.","J44.9","Z87.891","Z79.4","Z79.82","Z88.1","Z88.8","Z79.899","M62.838","G43.009","E11.65","E83.42","E87.6","J44.1","E78.5","Z91.19","M79.672","M79.671","Z23.","R05.","R09.81","R06.89","J06.9","B97.89","Z20.822","R52.","J45.21","J45.909","J45.901","Z01.419","G47.33","E11.8","R07.9"],"date":["2020-03-13","2020-11-21","2020-11-08","2021-09-16","2021-07-04","2021-07-04","2021-04-27","2021-04-14","2021-04-14","2021-04-14","2021-04-27","2021-04-27","2021-07-23","2021-09-16","2021-09-16","2020-11-08","2020-11-08","2020-11-08","2020-11-08","2020-11-08","2020-11-19","2021-09-09","2020-11-19","2020-11-19","2020-11-21","2020-12-14","2020-12-14","2021-02-25","2021-02-25","2020-01-08","2020-02-04","2020-02-04","2020-05-16","2021-04-17","2021-04-17","2021-04-17","2021-07-04","2020-05-16","2021-09-16","2020-11-21","2021-07-27","2021-09-16","2021-09-16","2021-10-09"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",null]}},{"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":[["","00487950125","ALBUTEROL","0.08%","150","Select","Select",""],["","08290320109","BD  PEN NEEDL","31GX8MM","100","Select","Select",""],["","68645058259","METFORMIN ","500MG","180","Select","Select",""],["","00487950125","ALBUTEROL ","0.08%","150","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","59746017509","PREDNISONE ","20MG","12","Select","Select",""],["","00088221905","LANTUS ","100\/ML","15","Select","Select",""],["","00597008717","ATROVENT ","17MCG","13","Select","Select",""],["","73070010315","INSULIN ","FLEXPEN","15","Select","Select",""],["","00169633910","NOVOLOG ","FLEXPEN","15","Select","Select",""],["","00597010061","SPIRIVA ","2.5MCG","4","Select","Select",""],["","68645048054","ATORVASTATIN ","10MG","30","Select","Select",""],["","00006483703","PNEUMOVAX ","25\/0.5","0","Select","Select",""],["","31722070190","LOSARTAN ","50MG","30","Select","Select",""],["","00173068220","VENTOLIN ","","18","Select","Select",""],["","49281072010","FLUBLOK ","2020-21","0","Select","Select",""],["","00173069700","ADVAIR ","500\/50","60","Select","Select",""],["","00173088710","TRELEGY ","ELLIPTA","60","Select","Select",""],["","66993058697","FLUTIC\/SALME ","500\/50","60","Select","Select",""],["","00115174501","METAXALONE ","400MG","20","Select","Select",""],["","65162019011","NAPROXEN ","500MG","20","Select","Select",""],["","50111078710","AZITHROMYCIN ","250MG","30","Select","Select",""],["","53885000810","ONETOUCH ","PLUS 33G","100","Select","Select",""],["","00597015230","JARDIANCE ","10MG","30","Select","Select",""],["","59267100001","PFIZER ","COVID-19","0","Select","Select",""],["","31722070190","LOSARTAN","50MG","30","Select","Select",""],["","68645048054","ATORVASTATIN","10MG","30","Select","Select",""],["","66993058697","FLUTIC\/SALME","500\/50","60","Select","Select",""],["","68645058259","METFORMIN","500MG","60","Select","Select",""],["","08290320109","BD PEN NEEDL","31GX8MM","100","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","59746017509","PREDNISONE","20MG","12","Select","Select",""],["","00169633910","NOVOLOG","FLEXPEN","15","Select","Select",""],["","73070010315","INSULIN","FLEXPEN","15","Select","Select",""],["","00088221905","LANTUS","100\/ML","15","Select","Select",""],["","00597008717","ATROVENT","17MCG","13","Select","Select",""],["","00173088710","TRELEGY","ELLIPTA","60","Select","Select",""],["","00597010061","SPIRIVA","2.5MCG","4","Select","Select",""],["","00006483703","PNEUMOVAX","25\/0.5","0","Select","Select",""],["","00115174501","METAXALONE","400MG","20","Select","Select",""],["","00173068220","VENTOLIN","","18","Select","Select",""],["","49281072010","FLUBLOK","2020-21","0","Select","Select",""],["","65162019011","NAPROXEN","500MG","20","Select","Select",""],["","00173069700","ADVAIR","500\/50","60","Select","Select",""],["","50111078710","AZITHROMYCIN","250MG","30","Select","Select",""],["","53885000810","ONETOUCH","PLUS 33G","100","Select","Select",""],["","59267100001","PFIZER","COVID-19","0","Select","Select",""],["","00597015230","JARDIANCE","10MG","30","Select","Select",""],["","89158500400","CAREFINE ","MIS 32GX4MM","400","Select","Select",""],["","00832105415","BACLOFEN ","TAB 10MG","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","",""],["Yes","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":""}]}]}