{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LAURA   L ELLIS","gend":1,"add":"654 BROWNSVIEW LN","city":"SURRY","state":"VA","zip":"23883-9998","dob":"1956-01-15","age":"","mstatus":"","insh":"20060418*01","cliId":"","pno":"757\/403-3601","cno":"757\/403-3601","email":"","ename":"","eno":"","pphy":"MOHSIN, SHEBA H MD","ppno":"757\/345-2555","pcpadd":"120 KINGS WAY SUITE 1400","pcpcity":"WILLIAMSBURG","pcpstate":"VA","pcpzip":23185,"pcpcounty":"","pcpid":"","pcpname":"Riverside Williamsburg Family Medicine","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/345-0366","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N28.89","I10.","E78.5","E05.00","F44.4","M79.662","E66.9","Z68.41","Z79.899","E78.00","Z88.8","Z88.0","M79.606","R50.9","N30.00","J06.9","M79.2","F51.05","F99.","K21.9","E53.8","G90.09","Z20.828","Z03.818","H25.813","H52.13","H53.8","H04.123","H52.223","H52.4"],"date":["2020-02-25","2021-05-29","2021-01-29","2021-05-29","2020-02-25","2021-05-29","2021-05-29","2021-05-29","2021-05-29","2021-05-29","2021-05-29","2021-05-29","2021-05-29","2020-02-16","2020-02-16","2020-02-16","2021-01-29","2021-01-29","2021-01-29","2021-01-29","2021-05-24","2020-06-20","2021-01-18","2021-01-18","2021-05-27","2021-05-27","2021-05-27","2021-05-27","2021-05-27","2021-05-27"],"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":[]},{"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":[["","67877022210","GABAPENTIN","CAP 100MG","180","Select","Select",""],["","16729018201","HYDROCHLOROT","TAB 12.5MG","90","Select","Select",""],["","00781518792","LEVOTHYROXIN","TAB 150MCG","30","Select","Select",""],["","68645019059","METOPROL","TAB 50MG","180","Select","Select",""],["","16714068303","SIMVASTATIN","TAB 20MG","90","Select","Select",""],["","50111043301","TRAZODONE","TAB 50MG","90","Select","Select",""],["","42806054701","VITAMIN","CAP 1.25MG","5","Select","Select",""],["","00274230015","ERO","SOL REMOVAL","15","Select","Select",""],["","72305013730","EUTHYROX","TAB 137MCG","90","Select","Select",""],["","70069000510","CYANOCOBALAM","INJ 1000MCG","2","Select","Select",""],["","00536252525","CAPSAICIN","CRE 0.00025","60","Select","Select",""],["","00904672040","ACETAMIN","TAB 500MG","20","Select","Select",""],["","49035048462","ACETAMINOPHN","TAB 500MG","20","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":""}]}]}