{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JEWELIA DENNING","gend":1,"add":"2310 SEAFORD ROAD","city":"SEAFORD","state":"VA","zip":"23696-9998","dob":"1988-04-21","age":"","mstatus":"","insh":"1456446*01","cliId":"","pno":"757\/719-4128","cno":"","email":"","ename":"","eno":"","pphy":"JONES, JOEL M DO","ppno":"757\/316-5050","pcpadd":"209 VILLAGE AVE STE P","pcpcity":"YORKTOWN","pcpstate":"VA","pcpzip":"23693","pcpcounty":"","pcpid":"","pcpname":"Riverside Tappahannock Hospital - ED","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/369-2999","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z01.419","Z11.3","F31.81","F41.1","F90.2","E89.0","E83.51","E55.9","Z76.89","Z71.3","Z71.82","Z86.16","F17.210","M54.89","R07.9","F90.9","Z91.018","E07.9","Z91.048","Z79.890","Z79.899","M25.552","M79.645","S60.012A","M79.604","M79.605","U07.1","M25.561","M25.511","M54.2","S63.602A"],"date":["2020-05-19","2020-05-19","2021-12-14","2021-12-14","2021-12-14","2020-07-31","2020-07-31","2020-07-31","2020-07-31","2020-07-31","2020-07-31","2021-09-09","2021-09-16","2021-09-16","2021-09-16","2021-09-16","2021-09-16","2021-09-16","2021-09-16","2021-09-16","2021-12-14","2020-04-07","2021-10-05","2021-10-05","2020-03-30","2020-03-30","2021-08-19","2021-10-12","2020-06-25","2020-06-25","2021-09-02"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}}]},{"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":[]},{"a":[]},{"a":{"indx":[false,false],"comment":["",""],"score":["",""]}},{"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":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","55111053405","DIVALPROEX","TAB 500MG ER","30","Select","Select",""],["","69452015120","VITAMIN","CAP 50000UNT","12","Select","Select",""],["","00115180401","HYDROXYZ","CAP 50MG","120","Select","Select",""],["","00591024105","LORAZEPAM","TAB 1MG","15","Select","Select",""],["","00406895401","AMPHET\/DEXTR","CAP 20MG ER","60","Select","Select",""],["","64380080707","IBUPROFEN","TAB 800MG","20","Select","Select",""],["","00173068220","VENTOLIN","AER ","18","Select","Select",""],["","54092038701","ADDERALL","CAP 20MG","60","Select","Select",""],["","50111033402","METRONIDAZOL","TAB 500MG","14","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","68462019005","NAPROXEN","TAB 500MG","20","Select","Select",""],["","69238183801","LEVOTHYROXIN","TAB 150MCG","90","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","18","Select","Select",""],["","70954005920","PREDNISONE","TAB 10MG","39","Select","Select",""],["","00591352530","LIDOCAINE","PAD 0.05","30","Select","Select",""],["","52817033010","CYCLOBENZAPR","TAB 5MG","15","Select","Select",""]]}},{"a":[]},{"a":[]},{"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":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":[]}]},{"t":"Mini-Cog","q":[{"a":[]},{"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":"","a13":""}]}]}