{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ERIC JONES","gend":0,"add":"1328 49TH ST","city":"NORFOLK","state":"VA","zip":"23508-9998","dob":"1962-08-09","age":"","mstatus":"","insh":"20040120*01","cliId":"","pno":"757\/918-3400","cno":"","email":"","ename":"","eno":"","pphy":"FEDRO, RANDALL C MD","ppno":"757\/686-3516","pcpadd":"3235 BRIDGE RD STE 15","pcpcity":"SUFFOLK","pcpstate":"VA","pcpzip":"23435","pcpcounty":"","pcpid":"","pcpname":"North Suffolk Family Medicine","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/686-0230","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K62.5","E66.9","M54.9","G89.29","K64.8","H40.1133","H40.1113","L85.3","L85.1","L60.0","B35.1","M51.26","M62.838","E78.5","R73.03","D12.8","E11.40","H25.13","L60.3","Z01.818","E11.9","Z79.899","M51.36","K63.5","Z12.5","E11.65"],"date":["2020-05-22","2020-02-07","2020-02-07","2021-12-03","2020-08-07","2021-11-30","2021-01-22","2021-07-22","2021-07-22","2021-11-23","2021-11-23","2021-12-03","2021-08-27","2021-12-03","2021-08-27","2020-05-22","2021-04-22","2021-11-30","2021-01-21","2020-05-20","2021-12-03","2021-12-03","2021-12-03","2020-05-22","2021-05-27","2021-11-23"],"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":[["","00023921105","COMBIGAN","SOL 0.2\/0.5%","10","Select","Select",""],["","24208046325","LATANOPROST","SOL 0.00005","5","Select","Select",""],["","60505025203","TIZANIDINE","TAB 4MG","90","Select","Select",""],["","42858010301","OXYCOD\/APAP","TAB 7.5-325","60","Select","Select",""],["","68180072003","AMLODIPINE","TAB 5MG","90","Select","Select",""],["","68382097001","CHLORTHALID","TAB 25MG","90","Select","Select",""],["","70727049725","RHOPRESSA","SOL 0.0002","2","Select","Select",""],["","68382075810","METFORMIN","TAB 500MG","90","Select","Select",""],["","76385011350","CARVEDILOL","TAB 25MG","180","Select","Select",""],["","60758011905","PREDNISOLONE","SUS 1% OP","5","Select","Select",""],["","70377000315","SIMVASTATIN","TAB 20MG","90","Select","Select",""],["","80777027398","MODERNA","INJ COVID-19","0","Select","Select",""],["","51991074790","DULOXETINE","CAP 30MG","30","Select","Select",""],["","49281042150","FLUZONE","INJ 2021-22","0","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":""}]}]}