{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SHERAINE   S BAILEY","gend":1,"add":"2429 CROMWELL ROAD","city":"NORFOLK","state":"VA","zip":"23509-9998","dob":"1971-12-29","age":"","mstatus":"","insh":"20017855*01","cliId":"","pno":"757\/717-4892","cno":"","email":"","ename":"","eno":"","pphy":"VILLATE PRIETO, SUSANA MD","ppno":"757\/278-2240","pcpadd":"155 KINGSLEY LN STE 400","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23505,"pcpcounty":"","pcpid":"","pcpname":"DEPAUL MEDICAL ASSOCIATES","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/489-6469","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E11.9","R59.9","R73.03","E78.00","E55.9","F32.9","Z76.89","Z68.38","C50.411","Z17.1","Z01.419","C50.011","N39.41","L30.9","Z85.3","Z88.2","Z88.1","R21.","J45.40","J45.41","G47.33","J98.4","E11.00","R22.9","N39.3","Z68.36","H40.023","H04.123","R03.0","C50.919","E78.5","E66.01","L65.9","R59.0","B34.9","NO DATA","M51.36","M54.16","M47.27"],"date":["2020-04-15","2021-09-27","2021-09-27","2021-09-27","2021-09-27","2021-09-27","2021-09-27","2021-09-27","2021-10-25","2021-10-25","2020-08-14","2021-02-02","2020-02-03","2019-12-23","2019-12-23","2019-12-23","2019-12-23","2019-12-23","2019-08-12","2019-08-12","2019-09-10","2019-09-10","2019-08-12","2019-06-24","2019-02-11","2019-02-11","2019-04-08","2019-04-08","2019-10-22","2019-10-22","2019-10-22","2019-10-22","2019-10-22","2019-06-17","2022-06-09","2022-04-20","2022-04-20","2022-04-20","2022-04-01"],"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":[["","65162083366","DICLOFENAC","GEL 0.01","500","Select","Select",""],["","00591352530","LIDOCAINE","PAD 0.05","30","Select","Select",""],["","00143928501","AMOXICILLIN","TAB 875MG","20","Select","Select",""],["","00002143380","TRULICITY","INJ 0.75\/0.5","2","Select","Select",""],["","53746017801","METFORMIN","TAB 500MG ER","30","Select","Select",""],["","57237001830","DULOXETINE","CAP 30MG","30","Select","Select",""],["","65162018910","NAPROXEN","TAB 375MG","60","Select","Select",""],["","","TROSPIUM","CAP 60MG ER","","Select","Select",""],["","53885024450","ONETOUCH","TES ULTRA BL","50","Select","Select",""],["","68645051890","CYCLOBENZAPR","TAB 10MG","30","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","18","Select","Select",""],["","64380073706","VITAMIN","CAP 50000UNT","12","Select","Select",""],["","51224010150","PHENTERMINE","TAB 37.5MG","30","Select","Select",""],["","65702010110","ACCU-CHEK","KIT AVIVA PL","1","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","16714008210","HYDROXYZ","TAB 25MG","30","Select","Select",""],["","65702015610","SOFTCLIX","MIS LANCETS","100","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":""}]}]}