{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JAMES   M WINFIELD JR","gend":0,"add":"1204 COVEL ST","city":"NORFOLK","state":"VA","zip":"23523-9998","dob":"1965-06-08","age":"","mstatus":"","insh":"20069174*01","cliId":"","pno":"757\/617-0093","cno":"757\/617-0093","email":"","ename":"","eno":"","pphy":"","ppno":"","pcpadd":"","pcpcity":"","pcpstate":"","pcpzip":"","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"757\/752-7465","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":["I08.1","I27.20","I51.7","I48.19","I50.9","R06.89","F25.0","F33.1","Z03.89","F10.20","B18.2","I48.91","R09.02","Z86.79","I10.","F32.3","I42.8","I50.33","N18.9","NO DATA","I50.43","I13.0","R04.2","N17.9","Z20.822","E66.09","K21.9","F41.9","F17.210","M12.9","M62.838","E11.22","B19.20","M79.641","M79.644","R73.01","E55.9","R53.83","Z76.0","Z91.89","K52.1","E87.2","Z83.3","Z82.49","Z88.1","Z88.0","Z88.8","Z91.018","F14.10","F14.90","I50.23","I42.0"],"date":["2021-06-28","2021-06-28","2021-06-28","2021-06-29","2021-11-01","2021-06-25","2021-07-28","2021-07-28","2021-07-28","2021-07-28","2021-11-03","2021-11-03","2021-06-25","2021-06-25","2021-11-02","2021-06-25","2021-06-25","2021-07-01","2021-06-25","2021-11-01","2021-10-31","2021-10-31","2021-06-25","2021-10-31","2021-10-31","2021-06-25","2021-10-31","2021-10-31","2021-06-25","2021-06-25","2021-06-25","2021-06-25","2021-07-02","2020-10-29","2020-10-29","2020-10-29","2021-07-02","2020-10-29","2021-07-02","2021-07-02","2021-10-31","2021-10-31","2021-10-31","2021-10-31","2021-10-31","2021-10-31","2021-10-31","2021-10-31","2021-10-31","2021-11-03","2021-11-02","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":[["","54092060601","XIIDRA","5%","60","Select","Select",""],["","31722094901","OXYCOD\/APAP","5-325MG","90","Select","Select",""],["","64380073706","VITAMIN","50000UNT","8","Select","Select",""],["","64764017530","DEXILANT","60MG DR","90","Select","Select",""],["","62037059890","CARTIA","180\/24HR","90","Select","Select",""],["","43547040211","FUROSEMIDE","40MG","90","Select","Select",""],["","43547035150","LISINOPRIL","2.5MG","90","Select","Select",""],["","16714089803","LORATADINE","10MG","90","Select","Select",""],["","58160082311","SHINGRIX","50\/0.5ML","1","Select","Select",""],["","00904645780","DOK","100MG","90","Select","Select",""],["","16729022517","SPIRONOLACT","25MG","90","Select","Select",""],["","49281042050","FLUZONE","2020-21","0","Select","Select",""],["","43547028950","BUPROPION","150MG SR","180","Select","Select",""],["","00003089421","ELIQUIS","5MG","180","Select","Select",""],["","68382080610","TRAZODONE","100MG","60","Select","Select",""],["","69547035302","NARCAN","","2","Select","Select",""],["","68462016305","CARVEDILOL","6.25MG","180","Select","Select",""],["","24979002707","DILTIAZEM","180MG ER","90","Select","Select",""],["","72626270101","SOFOS\/VELPAT","400-100","28","Select","Select",""],["","65862039010","ONDANSETRON","4MG ODT","60","Select","Select",""],["","00536110688","NICOTINE","7MG\/24HR","14","Select","Select",""],["","16714084402","AMIODARONE","200MG","32","Select","Select",""],["","31722082030","ARIPIPRAZOLE","5MG","30","Select","Select",""],["","00093031101","LOPERAMIDE","2MG","60","Select","Select",""],["","31722094901","OXYCOD\/APAP ","TAB 5-325MG","21","Select","Select",""],["","64380073706","VITAMIN ","CAP 50000UNT","8","Select","Select",""],["","54092060601","XIIDRA ","DRO 0.05","60","Select","Select",""],["","43547028950","BUPROPION ","TAB 150MG SR","180","Select","Select",""],["","00003089421","ELIQUIS ","TAB 5MG","180","Select","Select",""],["","68462016305","CARVEDILOL ","TAB 6.25MG","180","Select","Select",""],["","43547035150","LISINOPRIL ","TAB 2.5MG","90","Select","Select",""],["","16714089803","LORATADINE ","TAB 10MG","90","Select","Select",""],["","64764017530","DEXILANT ","CAP 60MG DR","90","Select","Select",""],["","62037059890","CARTIA ","CAP 180\/24HR","90","Select","Select",""],["","43547040211","FUROSEMIDE ","TAB 40MG","90","Select","Select",""],["","00904645780","DOK ","CAP 100MG","90","Select","Select",""],["","16729022517","SPIRONOLACT ","TAB 25MG","90","Select","Select",""],["","49281042050","FLUZONE ","INJ 2020-21","0","Select","Select",""],["","58160082311","SHINGRIX ","INJ 50\/0.5ML","1","Select","Select",""],["","68382080610","TRAZODONE ","TAB 100MG","60","Select","Select",""],["","69547035302","NARCAN ","SPR ","2","Select","Select",""],["","24979002707","DILTIAZEM ","CAP 180MG ER","90","Select","Select",""],["","00093031101","LOPERAMIDE ","CAP 2MG","60","Select","Select",""],["","72626270101","SOFOS\/VELPAT ","TAB 400-100","28","Select","Select",""],["","65862039010","ONDANSETRON ","TAB 4MG ODT","60","Select","Select",""],["","00536589553","NICOTINE ","DIS 14MG\/24H","14","Select","Select",""],["","31722082030","ARIPIPRAZOLE ","TAB 5MG","30","Select","Select",""],["","16714084402","AMIODARONE ","TAB 200MG","32","Select","Select",""],["","60505014601","OMEPRAZOLE ","CAP 40MG","30","Select","Select",""],["","55111046605","METOPROL ","TAB 25MG ER","30","Select","Select",""],["","42806071405","BENZONATATE ","CAP 100MG","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":""}]}]}