{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"HERIBERTO CINTRON JR","gend":0,"add":"69 TALL PINES WAY APT A","city":"NEWPORT NEWS","state":"VA","zip":"23606-9998","dob":"1959-01-26","age":"","mstatus":"","insh":"20060355*01","cliId":"","pno":"347\/805-8695","cno":"347\/805-8695","email":"","ename":"","eno":"","pphy":"KAMINER, JON J MD","ppno":"757\/594-3800","pcpadd":"10510 JEFFERSON AVENUE STE A","pcpcity":"NEWPORT NEWS","pcpstate":"VA","pcpzip":23601,"pcpcounty":"","pcpid":135802,"pcpname":"Riverside Brentwood Medical Center","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/594-3818","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E11.9","I10.","F32.9","M54.5","G89.29","NO DATA","M25.511","M25.512","N40.1","M54.17","I50.9","F41.0","R09.81","R06.00","K21.9","J34.89","J34.2","J31.0","R13.14","M51.17","M47.897","Z00.00","Z12.11","E78.2","F41.1","F33.1","R31.21","R21.","R07.9","Z23.","Z13.220","Z13.0","Z51.81","Z12.5","Z11.3","Z11.4","N47.8","J02.9","E11.69","R35.1","R39.14","R35.0","R39.12","N52.1","N47.1","N47.6","M51.36","G25.3","J30.1","R09.82"],"date":["2021-01-20","2021-03-23","2020-09-08","2021-04-06","2021-06-18","2021-04-06","2021-04-06","2021-04-06","2021-07-09","2020-07-28","2020-07-28","2020-07-28","2021-03-23","2020-07-28","2021-10-27","2021-03-23","2021-03-23","2021-03-23","2020-08-24","2021-06-18","2021-06-18","2020-03-05","2020-03-05","2020-04-17","2020-03-05","2020-03-05","2020-03-05","2020-03-05","2020-05-06","2021-03-11","2020-02-19","2020-02-19","2020-02-19","2020-02-19","2020-02-19","2020-02-19","2020-05-27","2021-01-20","2021-07-09","2021-07-09","2021-07-09","2021-07-09","2021-07-09","2021-07-09","2020-05-27","2020-05-27","2021-08-16","2021-10-27","2021-10-27","2021-10-27"],"priorHcc":["","","","","","","","","","","","","","",null,"","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",null,null,null]}},{"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":[["","68382009401","CARVEDILOL ","12.5MG","60","Select","Select",""],["","67877019905","AMLODIPINE ","10MG","30","Select","Select",""],["","67877056105","METFORMIN ","500MG","60","Select","Select",""],["","60505258009","ATORVASTATIN ","40MG","30","Select","Select",""],["","00591086201","LISINOP\/HCTZ ","20-25MG","30","Select","Select",""],["","68462063945","NITROGLYCERN ","0.4MG","75","Select","Select",""],["","67877021901","CEPHALEXIN ","500MG","6","Select","Select",""],["","13668010401","ISOSORB ","30MG ER","30","Select","Select",""],["","57237010099","METOPROL ","25MG","30","Select","Select",""],["","55111015901","OMEPRAZOLE ","40MG","30","Select","Select",""],["","31722094101","HYDROCO\/APAP ","5-325MG","10","Select","Select",""],["","27241012502","RANOLAZINE ","500MG ER","60","Select","Select",""],["","65862059801","TAMSULOSIN ","0.4MG","30","Select","Select",""],["","31722064430","TADALAFIL ","5MG","90","Select","Select",""],["","65162067684","AZELASTINE ","0.10%","30","Select","Select",""],["","53885059501","ONETOUCH ","30G","200","Select","Select",""],["","00597015230","JARDIANCE ","10MG","30","Select","Select",""],["","68382005101","MELOXICAM ","15MG","30","Select","Select",""],["","31722071390","PANTOPRAZOLE ","40MG","90","Select","Select",""],["","53885004401","ONE ","VERIO FL","1","Select","Select",""],["","67877056105","METFORMIN","500MG","60","Select","Select",""],["","60505257909","ATORVASTATIN","20MG","30","Select","Select",""],["","67877019905","AMLODIPINE","10MG","30","Select","Select",""],["","68180052001","LISINOP\/HCTZ","20-25MG","30","Select","Select",""],["","68382009401","CARVEDILOL","12.5MG","60","Select","Select",""],["","68462063945","NITROGLYCERN","0.4MG","75","Select","Select",""],["","13668010401","ISOSORB","30MG ER","30","Select","Select",""],["","27241012502","RANOLAZINE","500MG ER","60","Select","Select",""],["","65862059801","TAMSULOSIN","0.4MG","30","Select","Select",""],["","67877021901","CEPHALEXIN","500MG","6","Select","Select",""],["","31722094101","HYDROCO\/APAP","5-325MG","10","Select","Select",""],["","57237010099","METOPROL","25MG","30","Select","Select",""],["","31722064430","TADALAFIL","5MG","90","Select","Select",""],["","55111015901","OMEPRAZOLE","40MG","30","Select","Select",""],["","65162067684","AZELASTINE","0.10%","30","Select","Select",""],["","31722071390","PANTOPRAZOLE","40MG","90","Select","Select",""],["","53885059501","ONETOUCH","30G","200","Select","Select",""],["","00597015230","JARDIANCE","10MG","30","Select","Select",""],["","68382005101","MELOXICAM","15MG","30","Select","Select",""],["","53885004401","ONE","VERIO FL","1","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":""}]}]}