{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"RITA   K EDWARDS","gend":1,"add":"1220 RENOIR CT","city":"VIRGINIA BEACH","state":"VA","zip":23456,"dob":"1961-12-04","age":"","mstatus":"","insh":"20069514*01","cliId":"","pno":"757\/837-9426","cno":"757\/837-9426","email":"","ename":"","eno":"","pphy":"PEARMAN, STEVEN D MD","ppno":"757\/252-9800","pcpadd":"1380 TUSCANY DR","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23456,"pcpcounty":"","pcpid":117382,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/275-9793","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F13.20","F15.20","F98.8","F33.1","F41.1","Z00.00","Z20.828","B34.9","I48.0","I10.","Z72.0","K21.9","E78.5","F41.9","D50.9","R73.01","Z85.118","NO DATA","Z86.73","R61.","Z78.0","R51.9","J41.0","F19.11","Z76.0","E78.00","F90.2","J43.2","C34.12","F17.200","R05."],"date":["2021-09-01","2021-09-01","2021-06-09","2021-09-01","2021-09-01","2021-02-17","2021-04-19","2021-04-19","2021-06-30","2021-06-30","2021-06-30","2021-06-30","2021-06-30","2021-03-31","2021-02-17","2021-02-17","2021-06-30","2021-02-17","2021-06-30","2021-06-30","2021-06-30","2021-06-30","2021-09-10","2021-06-30","2020-12-09","2020-12-09","2021-09-01","2021-09-23","2021-09-10","2021-09-10","2021-09-10"],"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":[["","00555097302","AMPHET\/DEXTR ","20MG","75","Select","Select",""],["","55111012305","ATORVASTATIN ","40MG","30","Select","Select",""],["","68180098103","LISINOPRIL ","20MG","30","Select","Select",""],["","51862094205","DIAZEPAM ","5MG","90","Select","Select",""],["","69097084905","ESCITALOPRAM ","20MG","30","Select","Select",""],["","00363041414","ASPIRIN ","81MG EC","90","Select","Select",""],["","00378001805","METOPROL ","25MG","90","Select","Select",""],["","00363089688","NICOTINE ","21MG\/24H","28","Select","Select",""],["","00115166001","PROPRANOLOL ","20MG","60","Select","Select",""],["","68382050010","OMEPRAZOLE ","40MG","90","Select","Select",""],["","00573245114","NEXIUM ","20MG","60","Select","Select",""],["","00093005401","BUSPIRONE ","10MG","60","Select","Select",""],["","66993001968","ALBUTEROL ","HFA","54","Select","Select",""],["","80777027399","MODERNA ","COVID-19","0","Select","Select",""],["","00173068220","VENTOLIN ","","54","Select","Select",""],["","00115166001","PROPRANOLOL","20MG","60","Select","Select",""],["","00555097302","AMPHET\/DEXTR","20MG","75","Select","Select",""],["","65862037401","ESCITALOPRAM","10MG","45","Select","Select",""],["","51862094205","DIAZEPAM","5MG","90","Select","Select",""],["","55111012305","ATORVASTATIN","40MG","30","Select","Select",""],["","68180098103","LISINOPRIL","20MG","30","Select","Select",""],["","00573245114","NEXIUM","20MG","60","Select","Select",""],["","00378001805","METOPROL","25MG","60","Select","Select",""],["","00363041414","ASPIRIN","81MG EC","90","Select","Select",""],["","68382050010","OMEPRAZOLE","40MG","90","Select","Select",""],["","00363089688","NICOTINE","21MG\/24H","28","Select","Select",""],["","00173068220","VENTOLIN","","54","Select","Select",""],["","80777027399","MODERNA","COVID-19","0","Select","Select",""],["","66993001968","ALBUTEROL","HFA","54","Select","Select",""],["","00093100301","BUSPIRONE","15MG","60","Select","Select",""],["","00173088210","BREO","200-25","60","Select","Select",""],["","00597010051","SPIRIVA","2.5MCG","4","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":[[["No","Select","","","","","Select","",""],["No","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":""}]}]}