{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ELIZABETH ANDERSON","gend":1,"add":"103 N 4TH ST","city":"SUFFOLK","state":"VA","zip":"23434-9998","dob":"1950-07-11","age":"","mstatus":"","insh":"20038410*01","cliId":"","pno":"757\/809-1696","cno":"757\/809-1696","email":"","ename":"","eno":"","pphy":"MALIK, RAJUL MD","ppno":"757\/481-1113","pcpadd":"STE 201 1168 FIRST COLONIAL R","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23454,"pcpcounty":"","pcpid":113694,"pcpname":"Bridge Road Family Medicine","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/496-3822","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M19.012","K04.7","R10.9","I10.","D64.9","E11.9","E78.00","R63.4","Z23.","I70.211","I73.9","R10.13","K21.9","K43.9","Z86.010","Z87.19","Z86.73","M79.7","M19.90","I63.9","E78.5","M79.641","M19.041","R10.10","K29.50","Z79.84","H43.812","H18.413","M25.512","I34.0","R20.2","M19.042","R19.7","Z87.891","R20.0","R42.","NO DATA","E11.51","M12.9","Z95.5","Z91.040","Z79.899","Z09.","M12.819","K43.2","M62.08","E11.40","M20.41","M20.42","E11.49"],"date":["2020-02-04","2020-04-30","2020-10-08","2021-06-25","2020-06-11","2021-06-25","2020-09-16","2020-09-16","2021-03-30","2021-02-26","2021-02-26","2021-06-25","2021-06-25","2021-06-25","2021-06-25","2021-06-25","2021-06-25","2021-06-25","2021-06-25","2020-01-30","2020-01-17","2020-01-21","2020-03-03","2020-09-10","2020-09-10","2020-12-17","2020-12-17","2020-12-17","2020-02-26","2020-01-15","2020-01-15","2020-03-03","2020-10-08","2020-10-08","2020-01-15","2020-01-15","2020-05-12","2020-01-15","2020-01-15","2020-01-15","2020-01-15","2020-01-15","2020-01-30","2020-02-26","2020-07-08","2020-07-09","2021-03-17","2021-03-17","2021-03-17","2020-03-27"],"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":[["","55111019690","CLOPIDOGREL ","75MG","90","Select","Select",""],["","75987004005","PENNSAID ","2%","112","Select","Select",""],["","68180072003","AMLODIPINE ","5MG","30","Select","Select",""],["","00002143380","TRULICITY ","0.75\/0.5","2","Select","Select",""],["","00006008061","JANUMET ","50-1000","60","Select","Select",""],["","67877044730","OLMESA ","40MG","30","Select","Select",""],["","51991038490","FOLBIC ","","30","Select","Select",""],["","00555048302","AMILOR\/HCTZ ","May-50","30","Select","Select",""],["","68180029609","DULOXETINE ","60MG","30","Select","Select",""],["","55111064505","OMEPRAZOLE ","40MG","30","Select","Select",""],["","70377002911","ATORVASTATIN ","40MG","30","Select","Select",""],["","00832532515","POT  CL MICRO","20MEQ ER","60","Select","Select",""],["","00406012301","HYDROCO\/APAP ","5-325MG","12","Select","Select",""],["","53885027210","ONETOUCH ","VERIO","100","Select","Select",""],["","68180046403","SIMVASTATIN ","40MG","30","Select","Select",""],["","91237000128","ALCOHOL ","","100","Select","Select",""],["","00245531911","KLOR-CON ","20MEQ ER","60","Select","Select",""],["","00781261305","AMOXICILLIN ","500MG","28","Select","Select",""],["","00527058601","DICYCLOMINE ","10MG","30","Select","Select",""],["","68382052842","CHOLESTYRAM ","4GM","378","Select","Select",""],["","65862017601","PENICILLN ","500MG","21","Select","Select",""],["","08496080910","KROGER ","GLUCOSE","200","Select","Select",""],["","42192033901","HYOSCYAMINE ","0.125MG","60","Select","Select",""],["","70436015301","POT  CHLORIDE","20MEQ ER","60","Select","Select",""],["","49884068905","METOCLOPRAM ","10MG","30","Select","Select",""],["","68047025201","OSCIMIN ","0.125MG","90","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":""}]}]}