{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CLINTON   A WATKINS","gend":0,"add":"APT G PO BOX 172","city":"NEWPORT NEWS","state":"VA","zip":"23607-9998","dob":"1965-12-13","age":"","mstatus":"","insh":"20059331*01","cliId":"","pno":"757\/316-4781","cno":"","email":"","ename":"","eno":"","pphy":"ASPILI, CONCEPCION MD","ppno":"757\/874-8400","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\/928-0902","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M54.2","M54.5","R07.89","R26.89","I10.","E78.5","Z11.3","N50.89","N18.9","M47.812","G44.209","G47.33","N48.1","I50.20","T14.8XXA","A60.00","G43.909","I50.32","E66.9","G47.30","I25.10","M19.042","M46.90","E78.00","Z79.899","Z68.31","Z87.891","Z91.041","R42.","R06.00","Z12.5","R59.1","Z12.11","Z23.","Z80.0","K63.5","K57.30","D12.5","D12.3","I13.0","I50.40","M25.552","Z01.818","I50.30","Z99.89","G47.10","Z68.33","Z72.821","I49.9","R94.31","I11.0"],"date":["2021-04-13","2021-04-13","2020-11-10","2021-05-27","2021-08-26","2021-08-26","2021-02-16","2021-05-11","2021-08-26","2021-08-26","2021-04-30","2021-12-27","2021-01-01","2021-05-10","2021-08-26","2021-08-26","2021-08-26","2021-08-26","2021-04-30","2021-04-30","2021-04-30","2021-04-30","2021-04-30","2021-04-30","2021-04-30","2021-04-30","2021-04-30","2021-04-30","2021-04-30","2021-05-10","2021-06-29","2020-12-22","2020-05-18","2020-02-11","2020-05-18","2020-05-18","2020-05-18","2020-05-18","2020-05-18","2021-04-05","2021-04-05","2021-09-16","2020-03-10","2021-01-11","2021-12-27","2019-07-17","2019-07-17","2019-07-17","2019-09-16","2019-09-16","2019-09-16"],"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":[["","55111012405","ATORVASTATIN","TAB 80MG","90","Select","Select",""],["","68462016305","CARVEDILOL","TAB 6.25MG","180","Select","Select",""],["","75834012401","ACYCLOVIR","CAP 200MG","30","Select","Select",""],["","00591264001","BUT\/APAP\/CAF","CAP ","30","Select","Select",""],["","68084077725","ACETAMIN","TAB 650MG","30","Select","Select",""],["","68462018135","CLOTRIMAZOLE","CRE 0.01","30","Select","Select",""],["","68180072003","AMLODIPINE","TAB 5MG","90","Select","Select",""],["","00363033355","ARTHRTS","TAB 650MG","30","Select","Select",""],["","00781808926","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","00363033601","ACETAMINOPHE","TAB 650MG ER","30","Select","Select",""],["","59267100001","PFIZER","INJ COVID-19","0","Select","Select",""],["","52817033200","CYCLOBENZAPR","TAB 10MG","30","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":""}]}]}