{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MILTON   V WELCH","gend":0,"add":"700 WATERFRONT CIRCLE APT 206 124 MARTHA LEE DRIVE","city":"HAMPTON","state":"VA","zip":"23666-9998","dob":"1957-12-02","age":"","mstatus":"","insh":"20037117*01","cliId":"","pno":"757\/926-4362","cno":"","email":"","ename":"","eno":"","pphy":"TOUCHET, BRADLEY J MD","ppno":"757\/594-3800","pcpadd":"10510 JEFFERSON AVENUE STE A","pcpcity":"NEWPORT NEWS","pcpstate":"VA","pcpzip":23601,"pcpcounty":"","pcpid":"","pcpname":"Riverside Brentwood Medical Center","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"7576029131, 7573108453","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/594-3818","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R51.9","R00.1","F17.210","I25.10","I48.91","I50.9","J44.9","Z95.1","Z79.899","Z79.01","R07.9","R94.31","I48.0","R07.89","Z91.14","H53.8","I10.","Z72.0","Z23.","E78.5","M10.9","L70.9","Z91.19","R06.02","I11.0","F17.200","J32.0","Z76.0","E11.9","Z11.59","L91.0","K21.9","J30.2","F14.10","R42.","T40.5X1A","Z72.89","Z79.02","T67.5XXA","R97.20","Z11.4","R12.","I36.1","L29.9","R21.","Z79.82","M79.671","M79.673"],"date":["2021-11-01","2021-11-01","2022-06-03","2022-06-03","2022-06-03","2022-06-03","2022-06-03","2022-06-03","2022-06-03","2022-06-03","2021-12-17","2021-12-17","2021-12-17","2021-10-01","2021-10-19","2020-10-23","2021-11-01","2021-10-19","2021-10-19","2020-02-25","2020-02-25","2020-02-25","2020-02-25","2021-10-01","2021-10-01","2021-10-01","2020-09-22","2020-09-22","2021-10-19","2021-10-19","2021-10-19","2021-10-19","2021-10-19","2019-07-05","2019-07-05","2019-07-04","2019-07-04","2019-10-24","2019-07-04","2019-11-25","2019-11-25","2019-11-25","2019-07-05","2019-10-24","2019-10-24","2019-10-24","2022-06-03","2022-06-03"],"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":[["","00228282011","HYDROCHLOROT","TAB 12.5MG","30","Select","Select",""],["","67877056101","METFORMIN","TAB 500MG","30","Select","Select",""],["","45802006405","TRIAMCINOLON","CRE 0.001","15","Select","Select",""],["","16714085301","METOPROL","TAB 50MG ER","30","Select","Select",""],["","00003089421","ELIQUIS","TAB 5MG","60","Select","Select",""],["","55111012290","ATORVASTATIN","TAB 20MG","30","Select","Select",""],["","43598043611","NITROGLYCERN","SUB 0.4MG","25","Select","Select",""],["","00536117201","ACETAMIN","TAB 500MG","28","Select","Select",""],["","","SPIRIVA","CAP HANDIHLR","","Select","Select",""],["","55111015801","OMEPRAZOLE","CAP 20MG","60","Select","Select",""],["","00173068220","VENTOLIN","AER ","18","Select","Select",""],["","45802091939","CETIRIZINE","TAB 10MG","30","Select","Select",""],["","00904198359","MAPAP","TAB 500MG","28","Select","Select",""],["","10370082911","DILTIAZEM","CAP 120MG ER","30","Select","Select",""],["","53746010901","HYDROCO\/APAP","TAB 5-325MG","12","Select","Select",""],["","59746017506","PREDNISONE","TAB 20MG","15","Select","Select",""],["","","CARTIA","CAP 240\/24HR","","Select","Select",""],["","55111073001","ALLOPURINOL","TAB 300MG","30","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","18","Select","Select",""],["","00172572860","FAMOTIDINE","TAB 20MG","60","Select","Select",""],["","55111019630","CLOPIDOGREL","TAB 75MG","30","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","31722070230","LOSARTAN","TAB 100MG","30","Select","Select",""],["","68462026390","ROSUVASTATIN","TAB 20MG","30","Select","Select",""],["","00168020260","CLINDAMYCIN","GEL 0.01","60","Select","Select",""],["","","AMOXICILLIN","TAB 500MG","","Select","Select",""],["","","CARDIZEM","CAP 240MG\/24","","Select","Select",""],["","65862056099","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","13668010501","ISOSORB","TAB 60MG ER","60","Select","Select",""],["","68382012316","AMLODIPINE","TAB 10MG","30","Select","Select",""],["","00143301801","COLCHICINE","CAP 0.6MG","30","Select","Select",""],["","49348098053","SM","TAB 81MG EC","30","Select","Select",""],["","00603155404","POT  CHLORIDE","POW 20MEQ","30","Select","Select",""],["","42806016001","HYDROXYZ","TAB 25MG","30","Select","Select",""],["","68382078201","DOXYCYC","CAP 50MG","28","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":""}]}]}