{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DEBORAH   D REESE","gend":1,"add":"3951 POLLYPINE DR","city":"VIRGINIA BEACH","state":"VA","zip":"23452-9998","dob":"1960-03-12","age":"","mstatus":"","insh":"20033853*01","cliId":"","pno":"757\/837-6041","cno":"757\/837-6041","email":"","ename":"","eno":"","pphy":"SAMUELS, GARFIELD HUE MD","ppno":"757\/518-8823","pcpadd":"4452 CORPORATION LN STE 300","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23462,"pcpcounty":"","pcpid":148049,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/518-8832","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R06.02","G47.33","J45.50","J43.2","J44.9","M23.8X2","E11.9","I10.","M54.9","Z87.891","J45.21","G89.29","M25.512","M54.32","S90.121A","S70.12XA","A59.01","E55.9","J98.4","L73.2","Z71.3","Z82.49","L02.412"],"date":["2020-08-15","2021-09-27","2021-05-04","2020-11-25","2021-05-04","2021-04-16","2021-10-20","2021-09-25","2021-04-30","2021-09-25","2020-08-15","2021-04-01","2021-04-01","2021-04-01","2020-01-21","2020-01-21","2020-01-21","2020-07-08","2020-07-08","2021-09-25","2021-10-20","2021-09-25","2021-09-25"],"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":[["","29300022701","METRONIDAZOL ","500MG","14","Select","Select",""],["","00310460012","BEVESPI ","9-4.8MCG","11","Select","Select",""],["","59310058020","PROAIR ","","1","Select","Select",""],["","45802008801","ALBUTEROL ","HFA","8","Select","Select",""],["","43547035610","LISINOPRIL ","40MG","90","Select","Select",""],["","65162083366","DICLOFENAC ","1%","100","Select","Select",""],["","68180063609","ATORVASTATIN ","20MG","90","Select","Select",""],["","72647033104","METHYLPRED ","4MG","21","Select","Select",""],["","65162062710","TRAMADOL ","50MG","18","Select","Select",""],["","11822316910","RA ","81MG EC","90","Select","Select",""],["","59746017506","PREDNISONE ","20MG","15","Select","Select",""],["","00173071920","FLOVENT ","110MCG","12","Select","Select",""],["","00597015561","STIOLTO ","2.5-2.5","4","Select","Select",""],["","58657067601","CIPROFLOXACN ","500MG","9","Select","Select",""],["","70010075401","METHOCARBAM ","500MG","15","Select","Select",""],["","50742062001","NIFEDIPINE ","30MG ER","90","Select","Select",""],["","29300022701","METRONIDAZOL","500MG","14","Select","Select",""],["","59310058020","PROAIR","","1","Select","Select",""],["","00310460012","BEVESPI","9-4.8MCG","11","Select","Select",""],["","43547035610","LISINOPRIL","40MG","90","Select","Select",""],["","60505257909","ATORVASTATIN","20MG","90","Select","Select",""],["","11822316910","RA","81MG EC","90","Select","Select",""],["","72647033104","METHYLPRED","4MG","21","Select","Select",""],["","65162083366","DICLOFENAC","1%","100","Select","Select",""],["","45802008801","ALBUTEROL","HFA","8","Select","Select",""],["","59746017506","PREDNISONE","20MG","15","Select","Select",""],["","00173071920","FLOVENT","110MCG","12","Select","Select",""],["","00597015561","STIOLTO","2.5-2.5","4","Select","Select",""],["","65162062710","TRAMADOL","50MG","18","Select","Select",""],["","70010075401","METHOCARBAM","500MG","15","Select","Select",""],["","58657067601","CIPROFLOXACN","500MG","9","Select","Select",""],["","50742062001","NIFEDIPINE","30MG ER","90","Select","Select",""],["","51672140004","CLINDAMYCIN","1%","60","Select","Select",""],["","51672140004","CLINDAMYCIN ","LOT 0.01","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":""}]}]}