{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CAROLYN SCOTT","gend":1,"add":"229 GILMERTON AVE","city":"PORTSMOUTH","state":"VA","zip":"23704-9998","dob":"1949-12-08","age":"","mstatus":"","insh":"20049412*01","cliId":"","pno":"757\/397-0816","cno":"757\/397-0816","email":"","ename":"","eno":"","pphy":"MARKOVIC, VLADIMIR MD","ppno":"757\/393-6363","pcpadd":"3415 GRANBY STREET","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23504,"pcpcounty":"","pcpid":102266,"pcpname":"Park Place Family Medical Center","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["S82.875A","V54.16","E11.21","N18.3","Z68.32","Z23.","E11.65","R31.0","E78.00","Z71.3","Z71.89","I10.","E66.3","NO DATA"],"date":["2020-02-07","2020-06-16","2020-06-16","2020-06-16","2020-06-16","2021-11-03","2021-11-03","2020-05-13","2020-05-13","2021-02-25","2021-02-25","2021-11-03","2021-02-25","2021-11-03"],"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":[["","45802005911","NYSTATIN ","100000","30","Select","Select",""],["","00169406013","VICTOZA ","18MG\/3ML","18","Select","Select",""],["","42806005610","AMLODIPINE ","5MG","30","Select","Select",""],["","16714085301","METOPROL ","50MG ER","30","Select","Select",""],["","00603002632","ASPIRIN ","81MG EC","30","Select","Select",""],["","13668018230","ROSUVASTATIN ","40MG","30","Select","Select",""],["","62175013643","OMEPRAZOLE ","40MG","30","Select","Select",""],["","00378363705","CETIRIZINE ","10MG","30","Select","Select",""],["","16714066202","GABAPENTIN ","300MG","30","Select","Select",""],["","00002143480","TRULICITY ","1.5\/0.5","2","Select","Select",""],["","53885027150","ONETOUCH ","VERIO","100","Select","Select",""],["","51672400105","NORTRIPTYLIN ","10MG","30","Select","Select",""],["","56151014701","TRUPLUS ","33G","100","Select","Select",""],["","57515009563","PEN  NEEDLES  ","31GX6MM","100","Select","Select",""],["","00088221905","LANTUS ","100\/ML","15","Select","Select",""],["","45802006535","TRIAMCINOLON ","0.50%","30","Select","Select",""],["","00310653004","BYDUREON ","2MG","8","Select","Select",""],["","45963067611","METOPROLOL ","50MG ER","90","Select","Select",""],["","00228257111","INDAPAMIDE ","2.5MG","90","Select","Select",""],["","00378363705","CETIRIZINE","10MG","30","Select","Select",""],["","45802005911","NYSTATIN","100000","30","Select","Select",""],["","00169406013","VICTOZA","18MG\/3ML","18","Select","Select",""],["","42806005610","AMLODIPINE","5MG","30","Select","Select",""],["","00603002632","ASPIRIN","81MG EC","30","Select","Select",""],["","13668018230","ROSUVASTATIN","40MG","30","Select","Select",""],["","62175013643","OMEPRAZOLE","40MG","30","Select","Select",""],["","16714066202","GABAPENTIN","300MG","30","Select","Select",""],["","00088221905","LANTUS","100\/ML","15","Select","Select",""],["","16714085301","METOPROL","50MG ER","30","Select","Select",""],["","56151014701","TRUPLUS","33G","100","Select","Select",""],["","53885027150","ONETOUCH","VERIO","100","Select","Select",""],["","51672400105","NORTRIPTYLIN","10MG","30","Select","Select",""],["","00002143480","TRULICITY","1.5\/0.5","2","Select","Select",""],["","45802006535","TRIAMCINOLON","0.50%","30","Select","Select",""],["","57515009563","PEN NEEDLES","31GX6MM","100","Select","Select",""],["","00310653004","BYDUREON","2MG","8","Select","Select",""],["","45963067611","METOPROLOL","50MG ER","90","Select","Select",""],["","00228257111","INDAPAMIDE","2.5MG","90","Select","Select",""],["","00378214601","SPIRONOLACT ","TAB 25MG","30","Select","Select",""],["","80777027398","MODERNA ","INJ COVID-19","0","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":""}]}]}