{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TIFENEY   T SMITH","gend":1,"add":"PO BOX 5","city":"ATLANTIC","state":"VA","zip":"23303-9998","dob":"1976-11-06","age":"","mstatus":"","insh":"8551367*01","cliId":"","pno":"757\/824-0893","cno":"757\/824-0893","email":"","ename":"","eno":"","pphy":"LINGEN, JOAN MD","ppno":"757\/331-1086","pcpadd":"17068 LANKFORD HWY","pcpcity":"EASTVILLE","pcpstate":"VA","pcpzip":23347,"pcpcounty":"","pcpid":130007,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/442-9505","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z30.42","J02.9","M25.521","M54.5","G89.29","R03.0","M77.11","L65.9","R07.9","F10.10","R74.8","I10.","R65.10","R00.0","R74.0","K21.9","R11.2","K59.00","M54.16","Z12.31","A41.9","N12.","F10.129","M67.431","M54.41","M25.551","R94.5","E78.00","K92.0","I49.9","Z01.419","Z12.4","R13.10","R79.89","G62.2","NO DATA"],"date":["2021-09-08","2020-02-20","2020-05-20","2020-02-20","2020-02-20","2020-02-20","2021-03-16","2021-03-08","2020-03-06","2020-03-16","2020-03-06","2020-03-06","2020-03-06","2020-03-06","2020-03-06","2021-06-02","2021-05-07","2021-04-02","2021-09-08","2021-06-02","2020-03-05","2020-03-05","2020-03-05","2020-01-30","2020-01-30","2020-05-20","2020-05-20","2020-05-20","2020-05-27","2020-03-05","2020-12-15","2020-12-15","2021-05-07","2021-05-07","2021-11-12","2021-11-12"],"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":[["","67877032105","IBUPROFEN ","800MG","90","Select","Select",""],["","52817033200","CYCLOBENZAPR ","10MG","30","Select","Select",""],["","59762040105","SUCRALFATE ","1GM","120","Select","Select",""],["","62175061743","PANTOPRAZOLE ","40MG","30","Select","Select",""],["","00093031105","LOPERAMIDE ","2MG","30","Select","Select",""],["","21922000909","DICLOFENAC ","1%","200","Select","Select",""],["","00536105224","PEG3350 ","","238","Select","Select",""],["","00781502207","METHYLPRED ","4MG","21","Select","Select",""],["","00378773293","ONDANSETRON ","4MG ODT","30","Select","Select",""],["","00591530710","PROMETHAZINE ","25MG","30","Select","Select",""],["","67877022310","GABAPENTIN ","300MG","30","Select","Select",""],["","67877032105","IBUPROFEN","800MG","90","Select","Select",""],["","59762040105","SUCRALFATE","1GM","120","Select","Select",""],["","62175061743","PANTOPRAZOLE","40MG","30","Select","Select",""],["","00378773293","ONDANSETRON","4MG ODT","30","Select","Select",""],["","21922000909","DICLOFENAC","1%","200","Select","Select",""],["","00591530710","PROMETHAZINE","25MG","30","Select","Select",""],["","00536105224","PEG3350","","238","Select","Select",""],["","00781502207","METHYLPRED","4MG","21","Select","Select",""],["","67877022310","GABAPENTIN","300MG","30","Select","Select",""],["","52817033200","CYCLOBENZAPR","10MG","30","Select","Select",""],["","00093031105","LOPERAMIDE","2MG","30","Select","Select",""],["","55111018010","TIZANIDINE ","TAB 4MG","90","Select","Select",""],["","51293084610","FOLIC ","TAB 1MG","30","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","",""],["N\/A","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":""}]}]}