{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CURTIS MCDANIEL","gend":0,"add":"427 HAMPTON ROADS AVE APT 15","city":"HAMPTON","state":"VA","zip":"23661-9998","dob":"1961-12-30","age":"","mstatus":"","insh":"20054779*01","cliId":"","pno":"757\/755-0379","cno":"","email":"","ename":"","eno":"","pphy":"LORENZO, DAVID L MD","ppno":"757\/380-8709","pcpadd":"4714 MARSHALL AVE","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\/952-1345","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I10.","Z12.11","K70.30","M47.816","M51.36","G89.4","Z51.81","R13.10","R11.2","K27.9","K29.50","B96.81","F10.10","K29.70","K31.89","M54.32","K21.9","Z12.5","R73.03","A04.8","G89.29","M54.41","R13.19","K52.9","F10.188","M25.512","D12.2","D12.3","D12.4","K64.8","K70.9","NO DATA","M62.830","Z79.899","Z87.11","N39.0","R94.5","S82.425A","M25.572","Z03.89","V54.16","S82.832A","V18.2XXA","H40.023","H25.13","H04.123","H18.413","H11.153"],"date":["2021-12-16","2020-08-21","2021-09-09","2020-12-14","2021-12-16","2020-12-14","2020-12-14","2021-03-04","2021-06-02","2021-03-04","2021-09-09","2021-09-09","2021-09-09","2021-12-16","2021-09-09","2020-04-14","2021-09-09","2020-04-23","2020-04-23","2021-06-02","2020-09-11","2020-09-11","2020-10-22","2020-07-28","2021-12-16","2020-01-14","2020-08-21","2020-08-21","2020-08-21","2020-08-21","2020-09-16","2020-09-24","2020-12-07","2021-09-09","2021-09-09","2019-06-07","2019-06-07","2019-10-25","2019-12-03","2019-10-17","2019-12-03","2019-10-17","2019-10-17","2019-12-12","2019-12-12","2019-12-12","2019-12-12","2019-12-12"],"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":[["","50111033301","METRONIDAZOL","TAB 250MG","56","Select","Select",""],["","68382050010","OMEPRAZOLE","CAP 40MG","60","Select","Select",""],["","00591247501","TETRACYCLINE","CAP 500MG","56","Select","Select",""],["","01490010048","PEPTO-BISMOL","SUS 262\/15ML","473","Select","Select",""],["","","DAILY-VITE","TAB ","","Select","Select",""],["","59267100002","PFIZER","INJ COVID-19","0","Select","Select",""],["","68180072003","AMLODIPINE","TAB 5MG","30","Select","Select",""],["","00093220401","METOCLOPRAM","TAB 5MG","120","Select","Select",""],["","11917011540","VITAMIN","CAP 5000UNIT","30","Select","Select",""],["","","DICYCLOMINE","CAP 10MG","","Select","Select",""],["","00591352530","LIDOCAINE","PAD 0.05","30","Select","Select",""],["","65862039010","ONDANSETRON","TAB 4MG ODT","12","Select","Select",""],["","68462019005","NAPROXEN","TAB 500MG","20","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","20","Select","Select",""],["","00406048401","APAP\/CODEINE","TAB 300-30MG","12","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":""}]}]}