{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"RONALD   L HARRELL","gend":0,"add":"1819 VICTORIA BLVD","city":"HAMPTON","state":"VA","zip":"23661-9998","dob":"1963-02-14","age":"","mstatus":"","insh":"20028668*01","cliId":"","pno":"757\/755-5957","cno":"757\/795-5957","email":"","ename":"","eno":"","pphy":"WALLACE, DAVID M MD","ppno":"757\/726-5000","pcpadd":"200 EATON ST","pcpcity":"HAMPTON","pcpstate":"VA","pcpzip":23669,"pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Family Medicine Physicians - Old Hampton","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/726-5001","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N52.9","C61.","T28.911A","R42.","R03.0","J41.0","F17.200","Z71.89","Z12.11","I10.","K21.9","M54.5","G89.29","N52.01","K29.00","N52.31","M79.602","R10.84","F10.20","R63.0","M54.42"],"date":["2019-09-09","2019-09-09","2020-12-04","2019-04-16","2019-04-16","2019-04-16","2021-06-08","2020-12-08","2020-12-08","2020-12-08","2021-06-08","2020-12-08","2020-12-08","2019-03-07","2020-09-20","2019-06-18","2020-05-18","2021-06-08","2021-06-08","2021-06-08","2021-09-14"],"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":[["","00781286810","OMEPRAZOLE","CAP 20MG","30","Select","Select",""],["","00069046903","CHANTIX","PAK 1MG","112","Select","Select",""],["","00093117401","PENICILLN","TAB 500MG","28","Select","Select",""],["","68382005101","MELOXICAM","TAB 15MG","30","Select","Select",""],["","72888001405","CYCLOBENZAPR","TAB 10MG","60","Select","Select",""],["","","NAPROXEN","TAB 500MG","","Select","Select",""],["","","PRILOSEC","TAB 20MG","","Select","Select",""],["","","LIDOCAINE","PAD 0.05","","Select","Select",""],["","","CIPRO\/DEXA","SUS 0.3-0.1%","","Select","Select",""],["","","CIPRO\/FLUOC","DRO PF","","Select","Select",""],["","","PREDNISONE","TAB 20MG","","Select","Select",""],["","","CIPRODEX","SUS 0.3-0.1%","","Select","Select",""],["","","FLUARIX","INJ 2020-21","","Select","Select",""],["","00143924920","AMOX\/K","TAB 875-125","14","Select","Select",""],["","67877032105","IBUPROFEN","TAB 800MG","16","Select","Select",""],["","57237002801","AMOXICILLIN","TAB 500MG","30","Select","Select",""],["","65162044110","MECLIZINE","TAB 12.5MG","60","Select","Select",""],["","63304069301","CLINDAMYCIN","CAP 300MG","21","Select","Select",""],["","65162003310","APAP\/CODEINE","TAB 300-30MG","16","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":""}]}]}