{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SKIPPY  J MILLER","gend":0,"add":"3002 WILLIAMSBURG ROAD","city":"HENRICO","state":"VA","zip":23231,"dob":"1962-04-24","age":"","mstatus":"","insh":"20056585*01","cliId":"","pno":"804\/616-0621","cno":"","email":"","ename":"","eno":"","pphy":"Route,  barbara","ppno":"804\/780-0840","pcpadd":"5424 Discovery Park Blvd BLDB A STE 201","pcpcity":"WILLIAMSBURG","pcpstate":"VA","pcpzip":23231,"pcpcounty":"","pcpid":"","pcpname":"VERNON J HARRIS EAST END COMMUNITY HEALTH CENTER","plan":"OHP","program":"Medicaid","lob":"OHCC","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/420-1140","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F41.9","E11.65","E78.5","N40.0","M54.5","G47.00","N52.9","K21.9","J30.2","J06.9","R74.8","Z00.01","N40.1","Z79.899","F41.1","R53.83","Z72.0","Z76.0"],"date":["2022-05-11","2022-09-16","2022-05-11","2021-08-26","2019-11-21","2021-08-26","2021-08-26","2021-08-26","2019-04-15","2019-09-17","2021-05-25","2021-08-26","2020-03-25","2020-03-25","2022-11-10","2022-05-11","2022-05-11","2022-05-11"],"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":[["","65862049101","QUETIAPINE","TAB 100MG","60","Select","Select",""],["","49483060450","IBUPROFEN","TAB 800MG","90","Select","Select",""],["","42806008301","BUSPIRONE","TAB 7.5MG","60","Select","Select",""],["","65862029630","SILDENAFIL","TAB 100MG","27","Select","Select",""],["","69097083512","SERTRALINE","TAB 100MG","60","Select","Select",""],["","00115180301","HYDROXYZ","CAP 25MG","60","Select","Select",""],["","08290320550","BD  PEN NEEDL","MIS 32GX5\/32","100","Select","Select",""],["","00088221905","LANTUS","INJ 100\/ML","15","Select","Select",""],["","00597015330","JARDIANCE","TAB 25MG","90","Select","Select",""],["","57237001401","TAMSULOSIN","CAP 0.4MG","30","Select","Select",""],["","70377002811","ATORVASTATIN","TAB 20MG","30","Select","Select",""],["","00904679489","ASPIRIN","CHW 81MG","30","Select","Select",""],["","68382076010","METFORMIN","TAB 1000MG","60","Select","Select",""],["","57599080000","FREESTY","KIT 2 SENSOR","2","Select","Select",""],["","69452015120","VITAMIN","CAP 50000UNT","12","Select","Select",""],["","59651000305","OMEPRAZOLE","CAP 40MG","90","Select","Select",""],["","00228202950","ALPRAZOLAM","TAB 0.5MG","90","Select","Select",""],["","27241009903","DULOXETINE","CAP 60MG","30","Select","Select",""],["","69097094312","GABAPENTIN","CAP 300MG","90","Select","Select",""],["","00002879959","HUMALOG","INJ 100\/ML","15","Select","Select",""],["","69097052603","TADALAFIL","TAB 20MG","15","Select","Select",""],["","12843013105","BAYER","CHW 81MG","30","Select","Select",""],["","69238207707","PROPRANOLOL","TAB 10MG","30","Select","Select",""],["","53885027210","ONETOUCH","TES VERIO","200","Select","Select",""],["","50111045001","TRAZODONE","TAB 150MG","30","Select","Select",""],["","60505014201","GLIPIZIDE","TAB 10MG","60","Select","Select",""],["","65862050320","AMOX\/K","TAB 875-125","20","Select","Select",""],["","29300012510","CETIRIZINE","TAB 10MG","30","Select","Select",""],["","00406012505","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","00071101568","ACCU-CHEK","TES AVIVA PL","100","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":""}]}]}