{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DEVANY   G KING","gend":1,"add":"APT H PO BOX 9600","city":"HAMPTON","state":"VA","zip":"23670-9998","dob":"1971-09-09","age":"","mstatus":"","insh":"20030643*01","cliId":"","pno":"757\/329-0622","cno":"","email":"","ename":"","eno":"","pphy":"WEBSTER, ELIZABETH MD","ppno":"757\/975-5200","pcpadd":"7401 WARWICK BLVD","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\/223-0829","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E11.9","H25.013","R06.02","U07.1","NO DATA","I10.","E66.01","Z68.1","F17.200","Z79.84","Z79.899","R09.02","Z01.419","Z11.3","Z68.37","N76.0","Z12.31","Z28.21","Z72.0","R06.00","R05.9","Z20.822","M79.671","M79.672","L85.3","M20.41","M20.42","B35.1"],"date":["2021-10-16","2021-04-22","2021-10-19","2021-10-19","2021-10-19","2021-10-16","2021-10-16","2021-10-15","2021-10-15","2021-10-15","2021-10-15","2021-10-15","2021-03-17","2021-03-17","2021-03-17","2021-03-17","2021-03-17","2021-06-01","2021-10-16","2021-10-19","2021-10-19","2021-10-19","2019-02-12","2019-02-12","2019-02-12","2019-02-12","2019-02-12","2019-02-12"],"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":[["","16714069211","FLUCONAZOLE","TAB 150MG","1","Select","Select",""],["","68462031417","NYSTAT\/TRIAM","CRE ","15","Select","Select",""],["","53885004401","ONE","KIT VERIO FL","1","Select","Select",""],["","08222093592","INSULIN","MIS 0.5\/30G","100","Select","Select",""],["","00088222033","LANTUS","INJ 100\/ML","10","Select","Select",""],["","99073013001","FREESTYLE    MIS LANCETS","MIS LANCETS","100","Select","Select",""],["","70000011201","ALCOHOL","PAD 0.7","300","Select","Select",""],["","68180063509","ATORVASTATIN","TAB 10MG","60","Select","Select",""],["","00054418625","DEXAMETHASON","TAB 6MG","9","Select","Select",""],["","57896010205","ACETAMINOPHE","TAB 325MG","30","Select","Select",""],["","40985021240","MELATONIN","TAB 3MG","30","Select","Select",""],["","65862039010","ONDANSETRON","TAB 4MG ODT","20","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","53885024510","ONETOUCH","TES ULTRA","100","Select","Select",""],["","11822046713","PAIN","TAB 325MG","30","Select","Select",""],["","11822316910","RA","TAB 81MG EC","30","Select","Select",""],["","80681013500","ZINC","CAP 220MG","30","Select","Select",""],["","00904052380","VITAMIN","TAB 500MG","30","Select","Select",""],["","00173068220","VENTOLIN","AER ","18","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","36","Select","Select",""],["","99073070827","FREESTYLE    TES LITE","TES LITE","300","Select","Select",""],["","51224022060","METFORMIN","TAB 1000MG","60","Select","Select",""],["","31722070090","LOSARTAN","TAB 25MG","90","Select","Select",""],["","99073071227","FREESTYLE    TES INSULINX","TES INSULINX","300","Select","Select",""],["","00904675920","ROBAFEN","LIQ COUGH","118","Select","Select",""],["","99073070805","FREESTYLE    KIT LITE","KIT LITE","1","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":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"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":""}]}]}