{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JUANITA HALL","gend":1,"add":"177 WOODLAND ROAD APT 1","city":"HAMPTON","state":"VA","zip":"23663-9998","dob":"1957-03-08","age":"","mstatus":"","insh":"20028462*01","cliId":"","pno":"757\/746-9811","cno":"757\/790-5201","email":"","ename":"","eno":"","pphy":"LORENZO, DAVID L MD","ppno":"757\/380-8709","pcpadd":"4714 MARSHALL AVE","pcpcity":"NEWPORT NEWS","pcpstate":"VA","pcpzip":23607,"pcpcounty":"","pcpid":"","pcpname":"PENINSULA INSTITUTE FOR COMMUNITY HEALTH","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/952-1345","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G40.909","M19.90","R56.9","R40.1","Z87.898","Z87.891","K76.0","NO DATA","I10.","M54.9","G89.29","Z96.653","M25.561","M25.562","S82.201A","J44.9","R09.81","G89.4","F10.20","J45.909","E78.00","E03.9","J31.0","M10.9","K21.9","R60.9","M54.5","R73.09","F10.239","Z91.19","D64.9","F17.210","E78.5","Z79.02","Z79.51","Z79.890","Z79.899","S89.91XA","M79.661","W17.2XXA","Z01.810","V54.16","G89.18","T84.84XA","R41.82","S82.224A","S82.434A","F10.10","Z20.828","Z90.710","S82.424A","S82.401A","G93.40","R60.0","F05.","M89.9","E87.0","Z80.9","Z82.49","Z91.14","Z78.1","M17.9","S82.291A","G40.209","M62.82","F03.90","Z88.6","Z88.5","Z79.82","G40.009","R55.","I67.9","E55.9","R41.0","R53.1","R05.","Z01.818","Z28.21","Z53.20","I25.10","E87.2","S81.801A","E11.65","M23.91","Z79.891","M79.662","M25.369","J32.9","Z23.","Z48.02","Z12.31","S90.32XA"],"date":["2021-03-12","2020-07-08","2021-08-29","2020-05-01","2020-05-01","2021-08-29","2020-05-01","2021-03-12","2021-08-29","2020-10-27","2020-06-10","2021-08-29","2021-05-06","2020-10-16","2020-12-26","2021-08-29","2020-04-15","2021-02-10","2020-05-22","2021-05-06","2021-08-29","2021-08-29","2021-05-06","2020-05-22","2021-08-29","2020-05-22","2021-05-06","2020-05-22","2020-06-05","2020-06-05","2020-06-05","2020-06-05","2021-08-29","2021-08-29","2020-12-25","2021-08-29","2021-08-29","2020-12-25","2020-12-25","2020-12-25","2021-05-04","2021-06-03","2021-06-04","2021-06-04","2021-03-08","2020-12-25","2020-12-25","2021-03-08","2020-12-25","2021-08-29","2020-12-26","2020-12-26","2021-03-12","2021-06-23","2021-08-31","2020-03-18","2021-08-29","2021-03-08","2020-04-29","2021-03-08","2020-04-29","2020-10-27","2020-12-26","2021-08-29","2021-03-08","2021-03-08","2021-08-29","2021-03-08","2021-08-29","2021-11-24","2021-11-24","2020-05-01","2020-06-24","2021-08-29","2021-03-08","2021-05-06","2021-05-06","2021-05-06","2021-05-06","2021-06-04","2021-08-29","2019-02-12","2019-04-17","2019-04-17","2019-02-20","2019-03-12","2019-12-31","2019-12-31","2019-12-31","2019-02-26","2019-03-07","2019-10-10"],"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":[["","59310057922","PROAIR","AER ","8","Select","Select",""],["","42858010301","OXYCOD\/APAP","TAB 7.5-325","60","Select","Select",""],["","","DICLOFENAC","GEL 0.01","","Select","Select",""],["","69097081507","GABAPENTIN","CAP 400MG","90","Select","Select",""],["","","DAILY-VITE","TAB ","","Select","Select",""],["","","MELOXICAM","TAB 15MG","","Select","Select",""],["","65162062710","TRAMADOL","TAB 50MG","20","Select","Select",""],["","00143301801","COLCHICINE","CAP 0.6MG","30","Select","Select",""],["","00536379001","VITAMIN","CAP 2000UNIT","30","Select","Select",""],["","00054429731","FUROSEMIDE","TAB 20MG","30","Select","Select",""],["","55111019690","CLOPIDOGREL","TAB 75MG","30","Select","Select",""],["","60432026415","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","63824000820","MUCINEX","TAB 600MG ER","30","Select","Select",""],["","","SM","TAB 600MG","","Select","Select",""],["","60505257809","ATORVASTATIN","TAB 10MG","30","Select","Select",""],["","67877019805","AMLODIPINE","TAB 5MG","30","Select","Select",""],["","00186037220","SYMBICORT","AER 80-4.5","10","Select","Select",""],["","62756018488","OXCARBAZEPIN","TAB 300MG","120","Select","Select",""],["","70010077001","METHOCARBAM","TAB 750MG","60","Select","Select",""],["","80777027399","MODERNA","INJ COVID-19","0","Select","Select",""],["","76204020025","ALBUTEROL","NEB 0.00083","375","Select","Select",""],["","65162019010","NAPROXEN","TAB 500MG","60","Select","Select",""],["","00406012301","HYDROCO\/APAP","TAB 5-325MG","10","Select","Select",""],["","13668001760","LEVETIRACETA","TAB 1000MG","30","Select","Select",""],["","00093310953","AMOXICILLIN","CAP 500MG","30","Select","Select",""],["","69238115403","EZETIMIBE","TAB 10MG","30","Select","Select",""],["","40985021495","FISH","CAP 1000MG","90","Select","Select",""],["","65862085901","FAMOTIDINE","TAB 20MG","180","Select","Select",""],["","65162003310","APAP\/CODEINE","TAB 300-30MG","20","Select","Select",""],["","65162004710","OXYCODONE","TAB 5MG","20","Select","Select",""],["","","MONTELUKAST","TAB 10MG","","Select","Select",""],["","68180096501","LEVOTHYROXIN","TAB 25MCG","30","Select","Select",""],["","","ONDANSETRON","TAB 4MG","","Select","Select",""],["","","ASPIRIN","TAB 325MG EC","","Select","Select",""],["","29300012810","HYDROCHLOROT","TAB 25MG","60","Select","Select",""],["","69315012710","FOLIC","TAB 1000MCG","30","Select","Select",""],["","00904549280","THERA-M","TAB ","30","Select","Select",""],["","68462035701","POT  CHLORIDE","CAP 10MEQ ER","30","Select","Select",""],["","50111043301","TRAZODONE","TAB 50MG","30","Select","Select",""],["","","MUCUS","TAB 60-600MG","","Select","Select",""],["","57237000830","MIRTAZAPINE","TAB 15MG","30","Select","Select",""],["","","ACID","TAB 20MG","","Select","Select",""],["","","FLONASE","SPR 50MCG","","Select","Select",""],["","","BUDES\/FORMOT","AER 80-4.5","","Select","Select",""],["","11822880770","RA","CAP 1000MG","90","Select","Select",""],["","","CHLORDIAZEP","CAP 5MG","","Select","Select",""],["","","DULOXETINE","CAP 30MG","","Select","Select",""],["","","LIDOCAINE","CRE 0.04","","Select","Select",""],["","","EQL","TAB 600MG","","Select","Select",""],["","","CAPZASIN","GEL RELIEF","","Select","Select",""],["","69547035302","NARCAN","SPR ","2","Select","Select",""],["","","ESSENTL","TAB DAILY","","Select","Select",""],["","00173068220","VENTOLIN","AER ","18","Select","Select",""],["","11822331520","LORATADINE","TAB 10MG","30","Select","Select",""],["","00173069600","ADVAIR","AER 250\/50","60","Select","Select",""],["","66993058597","FLUTIC\/SALME","AER 250\/50","60","Select","Select",""],["","00378932132","WIXELA","AER 250\/50","60","Select","Select",""],["","55111015901","OMEPRAZOLE","CAP 40MG","30","Select","Select",""],["","37864000028","FERROUS","TAB 325MG","30","Select","Select",""],["","46122002878","GNP","TAB 600MG","30","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":""}]}]}