{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"GLADYS  B PERRY","gend":1,"add":"17924 FOX BRANCH ROAD","city":"DINWIDDIE","state":"VA","zip":23841,"dob":"1957-08-13","age":"","mstatus":"","insh":"20033342*01","cliId":"","pno":"804\/898-9278","cno":"","email":"","ename":"","eno":"","pphy":"Route,  barbara","ppno":"434\/246-6100","pcpadd":"5424 Discovery Park Blvd BLDB A STE 201","pcpcity":"WILLIAMSBURG","pcpstate":"VA","pcpzip":23841,"pcpcounty":"","pcpid":"","pcpname":"STONY CREEK COMMUNITY HEALTH CENTER","plan":"OHP","program":"Medicaid","lob":"OHCC","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/246-6137","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M06.9","Z79.899","M05.711","M25.511","Z13.820","Z01.419","R00.0","R30.0","E11.65","E11.42","I10.","E78.5","F17.210","D72.829","R06.83","Z79.4","Z91.11","Z91.19","K57.31","D62.","Z80.0","E11.9","K92.2","J31.0","J45.20","E66.09","N39.0","K92.1","K86.1","M79.609","E11.3293","H25.13","H52.03","Z79.84","K62.5","K63.5","D17.5","Z23.","Z20.822","Z79.82","Z79.52","S82.61XA","K12.0","J03.90","S82.831A","G89.11","S82.64XA","B37.3","M06.4","N95.1","D12.2","D12.3","D12.5","K57.30"],"date":["2021-10-10","2022-10-18","2021-10-26","2021-03-10","2020-01-27","2022-07-26","2021-10-10","2022-06-17","2021-10-26","2021-10-26","2021-10-26","2021-10-26","2021-10-26","2021-05-28","2021-01-05","2021-10-26","2021-10-26","2021-07-27","2021-10-11","2021-10-11","2021-10-12","2021-10-12","2021-10-12","2020-09-21","2020-09-21","2020-09-21","2020-11-03","2021-10-11","2021-10-10","2021-10-11","2021-12-10","2021-12-10","2021-12-10","2021-10-10","2021-10-26","2021-10-10","2021-10-11","2021-10-10","2021-10-10","2021-10-10","2021-10-10","2019-02-19","2019-10-24","2019-10-24","2019-02-16","2019-02-16","2019-02-19","2022-01-18","2022-10-18","2022-07-26","2021-10-11","2021-10-11","2021-10-11","2021-10-11"],"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":[["","00088222033","LANTUS","INJ 100\/ML","10","Select","Select",""],["","00591505210","PREDNISONE","TAB 5MG","58","Select","Select",""],["","63736044300","MONISTAT","KIT COMBO PK","24","Select","Select",""],["","11917001489","INSULIN","MIS 0.5\/29G","90","Select","Select",""],["","53885024450","ONETOUCH","TES ULTRA BL","300","Select","Select",""],["","58406044504","ENBREL","INJ 50MG\/ML","4","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","36","Select","Select",""],["","16729000617","SIMVASTATIN","TAB 40MG","30","Select","Select",""],["","51672128202","TRIAMCINOLON","CRE 0.001","60","Select","Select",""],["","","LEFLUNOMIDE","TAB 20MG","","Select","Select",""],["","57237000511","FLUCONAZOLE","TAB 150MG","1","Select","Select",""],["","23155010205","METFORMIN","TAB 500MG","60","Select","Select",""],["","00115175701","CYPROHEPTAD","TAB 4MG","90","Select","Select",""],["","65862020399","LOSARTAN","TAB 100MG","30","Select","Select",""],["","60432053716","NYSTATIN","SUS 100000","200","Select","Select",""],["","00378462126","ESTRADIOL","DIS 0.05MG","8","Select","Select",""],["","00002143380","TRULICITY","INJ 0.75\/0.5","2","Select","Select",""],["","00143992801","CIPROFLOXACN","TAB 500MG","10","Select","Select",""],["","00363041105","NICOTINE","LOZ 2MG MINT","72","Select","Select",""],["","53746027205","SMZ\/TMP","TAB 800-160","14","Select","Select",""],["","","NITROFUR","CAP 100MG","","Select","Select",""],["","00135051001","NICORETTE","LOZ 2MG MINT","72","Select","Select",""],["","69097052444","DICLOFENAC","GEL 0.01","100","Select","Select",""],["","80777027398","MODERNA","INJ COVID-19","0","Select","Select",""],["","00069047103","CHANTIX","PAK 0.5& 1MG","53","Select","Select",""],["","68462019005","NAPROXEN","TAB 500MG","60","Select","Select",""],["","","AZITHROMYCIN","TAB 250MG","","Select","Select",""],["","","BENZONATATE","CAP 100MG","","Select","Select",""],["","42167000554","LANCET","MIS THIN 30G","300","Select","Select",""],["","60758011905","PREDNISOLONE","SUS 1% OP","5","Select","Select",""],["","57237004290","VALACYCLOVIR","TAB 500MG","20","Select","Select",""],["","16714029904","AMOXICILLIN","CAP 500MG","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":{"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":""}]}]}