{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"THURBA   W JONES JR","gend":0,"add":"4205 CHESTNUT AVE","city":"NEWPORT NEWS","state":"VA","zip":"23607-9998","dob":"1960-06-25","age":"","mstatus":"","insh":"20030157*01","cliId":"","pno":"757\/380-8240","cno":"","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","G40.919","I10.","E11.9","Z79.899","Z79.84","Z79.82","R56.9","H35.033","N50.811","T14.8XXA","N50.812","H47.011","E78.00","Z12.11","Z12.5","Z23.","R14.1","G40.019","R55.","Z20.822","K63.5","R19.5","Z83.71","T88.7XXA","D12.5","D12.3","D12.0","K64.8","R07.9","NO DATA","R36.9","R51.9","E78.5"],"date":["2021-12-09","2021-06-30","2021-12-09","2021-12-27","2021-12-09","2021-12-09","2021-12-09","2021-12-09","2021-12-27","2021-05-07","2021-01-14","2021-05-07","2021-11-18","2021-09-30","2020-09-14","2020-09-14","2020-09-14","2021-02-23","2021-09-02","2021-09-02","2021-06-04","2021-06-07","2021-06-07","2021-06-07","2021-01-17","2021-06-07","2021-06-07","2021-06-07","2021-06-07","2020-10-07","2020-11-08","2020-11-08","2021-08-30","2021-09-30"],"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":[["","","AMLOD\/BENAZP"," AMLOD\/BENAZP ","30","Select","Select",""],["","","ATORVASTATIN"," ATORVASTATIN ","30","Select","Select",""],["","","LEVETIRACETA"," LEVETIRACETA ","360","Select","Select",""],["","","DIVALPROEX"," DIVALPROEX ","120","Select","Select",""],["","","GLIPIZIDE"," GLIPIZIDE ","60","Select","Select",""],["","","CVS"," CVS ","30","Select","Select",""],["","69584061150","METHOCARBAM","TAB 500MG","60","Select","Select",""],["","","ACARBOSE","TAB 50MG","","Select","Select",""],["","","DAILY-VITE","TAB ","","Select","Select",""],["","","ONETOUCH"," ONETOUCH ","100","Select","Select",""],["","49483060450","IBUPROFEN","TAB 800MG","30","Select","Select",""],["","","PREP","PAD ","","Select","Select",""],["","","ASPIRIN"," ASPIRIN ","30","Select","Select",""],["","","METFORMIN"," METFORMIN ","60","Select","Select",""],["","","CARVEDILOL"," CARVEDILOL ","60","Select","Select",""],["","68462041820","LIDOCAINE","OIN 0.05","35","Select","Select",""],["","00591565810","CYCLOBENZAPR","TAB 10MG","20","Select","Select",""],["","","CONTOUR"," CONTOUR ","1","Select","Select",""],["","","FREESTYLE    KIT FREEDOM"," FREESTYLE    KIT FREEDOM","1","Select","Select",""],["","","VITAMIN","TAB 1000MG","","Select","Select",""],["","","D","TAB 2000UNIT","","Select","Select",""],["","","MULTI-VITAMN","TAB ","","Select","Select",""],["","","BLOOD","MIS WRIST CF","","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":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"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":""}]}]}