{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LISA   M JOHNSON","gend":1,"add":"108 E MAIN ST","city":"WAKEFIELD","state":"VA","zip":"23888-9998","dob":"1972-12-01","age":"","mstatus":"","insh":"20030059*01","cliId":"","pno":"804\/497-2405","cno":"","email":"","ename":"","eno":"","pphy":"MIN, JOHN KIHO MD","ppno":"804\/447-9537","pcpadd":"10175 HULL STREET RD","pcpcity":"MIDLOTHIAN","pcpstate":"VA","pcpzip":23112,"pcpcounty":"","pcpid":"","pcpname":"ALLIANCE FAMILY PRACTICE INC","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/658-1805","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F33.3","I10.","E55.9","J30.2","F43.10","F41.1","T78.40XA","E04.2","G47.33","J30.9","J30.1","H10.45","Z91.018","E66.9","R06.83","L50.0","R55.","Z53.21","F31.81","Z68.41","K14.8","Z80.3","Z79.899","K21.9","R49.0","M79.641","M79.642","G56.03","Z13.9","Z20.822"],"date":["2021-12-16","2021-03-19","2021-03-19","2020-07-14","2021-06-22","2020-09-22","2020-07-14","2021-05-26","2021-05-26","2021-06-07","2021-06-07","2021-04-30","2021-04-30","2021-04-30","2021-04-30","2021-04-30","2019-08-20","2019-08-20","2020-09-22","2021-03-30","2019-09-04","2021-03-19","2021-03-19","2021-03-19","2021-03-19","2020-08-03","2020-08-03","2020-10-22","2021-05-24","2021-05-24"],"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":[["","","ALLERGY","TAB 180MG","","Select","Select",""],["","","HYDROXYZ"," HYDROXYZ ","120","Select","Select",""],["","","QUETIAPINE","TAB 25MG","","Select","Select",""],["","","ESCITALOPRAM"," ESCITALOPRAM ","30","Select","Select",""],["","","LATUDA"," LATUDA ","30","Select","Select",""],["","","MONTELUKAST","TAB 10MG","","Select","Select",""],["","","FLUTICASONE"," FLUTICASONE ","16","Select","Select",""],["","","DILTIAZEM"," DILTIAZEM ","30","Select","Select",""],["","","EPINEPHRINE"," EPINEPHRINE ","2","Select","Select",""],["","","FAMOTIDINE","TAB 20MG","","Select","Select",""],["","00054350049","LIDOCAINE","SOL 2% VISC","200","Select","Select",""],["","","CETIRIZINE","TAB 10MG","","Select","Select",""],["","","PREDNISONE","TAB 20MG","","Select","Select",""],["","40093010107","D3","CAP 125MCG","30","Select","Select",""],["","","HYDROCHLOROT"," HYDROCHLOROT ","30","Select","Select",""],["","","CLONIDINE"," CLONIDINE ","30","Select","Select",""],["","68001044000","FEXOFENADINE","TAB 180MG","30","Select","Select",""],["","","NAPROXEN","TAB 375MG","","Select","Select",""],["","","EPIPEN","INJ 0.3MG","","Select","Select",""],["","","VITAMIN","CAP 5000UNIT","","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":""}]}]}