{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LORRAINE PERKINS","gend":1,"add":"2050 LINSTER ST # A","city":"CHESAPEAKE","state":"VA","zip":"23324-9998","dob":"1967-03-11","age":"","mstatus":"","insh":"20033320*01","cliId":"","pno":"757\/216-2642","cno":"757\/216-2642","email":"","ename":"","eno":"","pphy":"MACK, ALEXANDRA S MD","ppno":"757\/446-5955","pcpadd":"825 FAIRFAX AVE SUITE 118","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23507,"pcpcounty":"","pcpid":100070,"pcpname":"EVMS Ghent Family Medicine","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/446-5196","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M21.6X1","M79.671","M21.6X2","M79.672","K02.9","B20.","G80.9","F32.9","I10.","M79.673","G89.29","E78.5","M25.569","E11.9","Z23.","R26.9","J06.9","G40.209","G40.309","M25.50"],"date":["2020-02-24","2020-02-24","2020-02-24","2020-02-24","2021-08-05","2021-08-05","2021-02-17","2021-08-05","2021-02-17","2020-01-10","2020-11-18","2021-08-05","2021-03-02","2020-11-18","2020-11-18","2020-11-18","2021-03-02","2020-09-22","2020-09-22","2020-11-11"],"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":[["","49884093547","DICLOFENAC ","1%","100","Select","Select",""],["","00904673060","ACETAMIN ","500MG","60","Select","Select",""],["","31722094101","HYDROCO\/APAP ","5-325MG","30","Select","Select",""],["","68180098001","LISINOPRIL ","10MG","30","Select","Select",""],["","00054327099","FLUTICASONE ","50MCG","16","Select","Select",""],["","00904582489","VITAMIN ","1000UNIT","30","Select","Select",""],["","68180011507","LEVETIRACETA ","1000MG","60","Select","Select",""],["","00378352091","FOSAMPRENAVI ","700MG","60","Select","Select",""],["","61958250101","BIKTARVY ","","30","Select","Select",""],["","00378623201","CITALOPRAM ","20MG","30","Select","Select",""],["","00172572860","FAMOTIDINE ","20MG","60","Select","Select",""],["","00536252525","CAPSAICIN ","0.03%","60","Select","Select",""],["","58160088552","FLUARIX ","2020-21","0","Select","Select",""],["","00904198359","MAPAP ","500MG","60","Select","Select",""],["","31722094101","HYDROCO\/APAP","5-325MG","30","Select","Select",""],["","00904582489","VITAMIN","1000UNIT","30","Select","Select",""],["","00172572860","FAMOTIDINE","20MG","60","Select","Select",""],["","68180011507","LEVETIRACETA","1000MG","60","Select","Select",""],["","00904673060","ACETAMIN","500MG","60","Select","Select",""],["","68180098001","LISINOPRIL","10MG","30","Select","Select",""],["","00054327099","FLUTICASONE","50MCG","16","Select","Select",""],["","00378875006","DICLOFENAC","1%","100","Select","Select",""],["","00378352091","FOSAMPRENAVI","700MG","60","Select","Select",""],["","00378623201","CITALOPRAM","20MG","30","Select","Select",""],["","61958250101","BIKTARVY","","30","Select","Select",""],["","70645002525","CAPSAICIN","0.03%","25","Select","Select",""],["","58160088552","FLUARIX","2020-21","0","Select","Select",""],["","00904198359","MAPAP","500MG","60","Select","Select",""],["","00131247835","VIMPAT ","TAB 100MG","60","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":""}]}]}