{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LARRY WILLIAMS","gend":0,"add":"622 E LEICESTER AVENUE APT 8 MARY A WILLIAMS","city":"NORFOLK","state":"VA","zip":"23503-9998","dob":"1958-02-21","age":"","mstatus":"","insh":"20037509*01","cliId":"","pno":"757\/364-8343","cno":"757\/364-8343","email":"","ename":"","eno":"","pphy":"MUSSELMANI, ZATTAM MD","ppno":"757\/543-3557","pcpadd":"1422 POINDEXTER ST","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":23324,"pcpcounty":"","pcpid":119860,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/543-0053","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F20.0","E11.3213","Z79.4","H40.013","H40.053","H52.03","H52.222","H52.4","L71.8","E11.21","F06.2","I10.","R39.81","M17.12","R42.","E11.9","I95.9","R07.9","F25.0","Z12.11","R05.","R06.02","R06.00","E11.3313","H25.13","I51.7","B37.0","F29.","N39.46","B35.1","I73.9","E11.51","E11.42","E11.3311","Z20.828","H43.823","E11.3393","E11.3391","E11.3312"],"date":["2021-06-16","2020-01-10","2020-01-10","2020-01-10","2020-01-10","2020-01-10","2020-01-10","2020-01-10","2020-07-08","2021-06-01","2021-01-07","2021-06-01","2021-07-28","2020-08-25","2020-06-03","2020-12-09","2020-01-06","2020-01-06","2021-06-01","2020-03-05","2020-05-13","2020-05-13","2020-05-13","2020-08-06","2021-08-10","2020-02-19","2020-04-15","2020-04-15","2020-06-19","2020-09-22","2020-09-22","2020-09-22","2020-09-22","2020-03-10","2020-05-13","2021-08-10","2020-11-10","2021-08-10","2021-08-10"],"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":[["","57896091136","ASPIRIN ","81MG","28","Select","Select",""],["","50383070016","FLUTICASONE ","50MCG","16","Select","Select",""],["","68382080605","TRAZODONE ","100MG","28","Select","Select",""],["","68180051703","LISINOPRIL ","40MG","28","Select","Select",""],["","51248015101","VESICARE ","10MG","28","Select","Select",""],["","16729016901","ESCITALOPRAM ","10MG","28","Select","Select",""],["","00093526456","SOLIFENACIN ","10MG","28","Select","Select",""],["","16729011917","MONTELUKAST ","10MG","28","Select","Select",""],["","60505257909","ATORVASTATIN ","20MG","28","Select","Select",""],["","00378075701","ATENOLOL ","100MG","28","Select","Select",""],["","00597014030","TRADJENTA ","5MG","28","Select","Select",""],["","60432053716","NYSTATIN ","100000","140","Select","Select",""],["","00088221905","LANTUS ","100\/ML","12","Select","Select",""],["","67877019990","AMLODIPINE ","10MG","28","Select","Select",""],["","68382011505","RISPERIDONE ","2MG","28","Select","Select",""],["","50458056301","INVEGA ","156MG\/ML","1","Select","Select",""],["","06043253760","","","140","Select","Select",""],["","08290320109","BD  PEN NEEDL","31GX8MM","100","Select","Select",""],["","29300012613","BISOPROL ","5MG","28","Select","Select",""],["","00168032346","METRONIDAZOL ","0.75%","45","Select","Select",""],["","00299383645","METROCREAM ","0.75%","45","Select","Select",""],["","67405065155","DOXYCYCL ","100MG","14","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","56151085050","TRUETRACK ","","50","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":""}]}]}