{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CAROLYN SADLER-ANDERSON","gend":1,"add":"608 LEE ST","city":"HAMPTON","state":"VA","zip":"23669-9998","dob":"1955-05-24","age":"","mstatus":"","insh":"20034424*01","cliId":"","pno":"757\/930-3705","cno":"757\/933-9659","email":"","ename":"","eno":"","pphy":"HARRIS, LAURIE H DO","ppno":"757\/825-4273","pcpadd":"2117 HARTFORD ROAD","pcpcity":"HAMPTON","pcpstate":"VA","pcpzip":23666,"pcpcounty":"","pcpid":"","pcpname":"FAMILY PRACTICE OF HAMPTON ROADS","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/825-4276","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F31.9","I10.","F31.12","E55.9","G40.209","Z23.","Z53.20","D72.825","NO DATA","Z68.37","S52.592A"],"date":["2021-11-03","2020-11-23","2020-11-23","2020-11-23","2020-11-23","2020-11-23","2020-11-23","2020-11-23","2020-11-23","2020-11-23","2019-07-14"],"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":[["","","PREGABALIN"," PREGABALIN ","120","Select","Select",""],["","","DULOXETINE"," DULOXETINE ","60","Select","Select",""],["","","ARIPIPRAZOLE"," ARIPIPRAZOLE ","30","Select","Select",""],["","","ALPRAZOLAM"," ALPRAZOLAM ","2","Select","Select",""],["","","PROAIR"," PROAIR ","8","Select","Select",""],["","","LISINOPRIL"," LISINOPRIL ","30","Select","Select",""],["","00555032302","HYDROXYZ","CAP 25MG","10","Select","Select",""],["","","BUSPIRONE"," BUSPIRONE ","90","Select","Select",""],["","59267100003","PFIZER","INJ COVID-19","0","Select","Select",""],["","00116200116","CHLORHEX","SOL 0.0012","473","Select","Select",""],["","","LAMOTRIGINE"," LAMOTRIGINE ","60","Select","Select",""],["","","RISPERIDONE","TAB 0.5MG","","Select","Select",""],["","","ALBUTEROL"," ALBUTEROL ","18","Select","Select",""],["","","NYAMYC"," NYAMYC ","30","Select","Select",""],["","","HYDROCHLOROT"," HYDROCHLOROT ","30","Select","Select",""],["","","LAMICTAL"," LAMICTAL ","60","Select","Select",""],["","","LYRICA"," LYRICA ","120","Select","Select",""],["","","HYDROCO\/APAP"," HYDROCO\/APAP ","12","Select","Select",""],["","","LORATADINE"," LORATADINE ","30","Select","Select",""],["","","VENTOLIN"," VENTOLIN ","18","Select","Select",""],["","","BUPROPION"," BUPROPION ","30","Select","Select",""],["","","PREVNAR","INJ ","","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":""}]}]}