{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CLARENCE FAULK","gend":0,"add":"30437 TUCKERS DR APT 16","city":"BOYKINS","state":"VA","zip":"23827-9998","dob":"1973-10-16","age":"","mstatus":"","insh":"20063885*01","cliId":"","pno":"757\/743-8089","cno":"757\/743-8089","email":"","ename":"","eno":"","pphy":"COUNCIL, DELORIS NP","ppno":"757\/562-2158","pcpadd":"102 FAIRVIEW DR STE B","pcpcity":"FRANKLIN","pcpstate":"VA","pcpzip":23851,"pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/516-8019","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F11.20","F33.1","F31.9","M54.5","F11.23","F33.2","Z01.810","G89.29","M54.41","E78.5","E78.00","M19.90","F17.210","M54.9","F31.4","E78.2","Z11.59","M79.672","Z68.25","H40.013","H16.223","M54.16","NO DATA","G89.4","F43.10","M51.26","M54.10","N52.9","Z72.0","F19.20","Z68.23","F43.12","F31.81","M25.561","L03.317","L02.92","M19.172","S93.326A","Z96.9","Z68.27","F20.9","F17.200","F12.90","Z20.828","M54.2","M54.12","M47.22","M50.10","F19.10","Z11.52","M19.072","M12.072","Z00.00","R73.9","Z20.2","M51.16","M54.17","M79.602","Z01.818","Z68.26","Z79.899","H17.821","M51.36","M96.1","T40.2X4A","G47.30","R40.4","R26.81","Z96.7","Z91.81","M23.91","F25.0"],"date":["2022-01-08","2022-07-08","2020-08-19","2021-03-19","2020-08-24","2022-09-08","2020-11-24","2022-06-15","2021-11-17","2021-11-17","2022-10-05","2021-11-17","2022-10-05","2021-11-17","2022-04-01","2022-05-17","2022-05-17","2022-05-17","2022-05-17","2022-07-13","2022-07-13","2022-10-11","2022-10-11","2022-10-11","2020-10-05","2022-01-21","2021-03-19","2021-09-17","2021-09-17","2021-09-17","2021-09-17","2022-07-08","2022-07-08","2020-05-21","2021-01-28","2020-07-29","2020-05-28","2020-05-28","2020-05-28","2020-11-03","2020-08-19","2020-08-19","2021-01-28","2021-07-20","2022-06-15","2022-06-15","2022-06-20","2022-06-20","2020-08-19","2021-03-30","2020-05-28","2020-05-28","2021-04-27","2021-04-27","2021-04-27","2022-05-09","2022-09-26","2022-06-07","2020-11-30","2020-11-30","2022-10-05","2021-07-09","2022-09-26","2022-09-26","2022-10-05","2022-10-05","2022-10-05","2020-04-15","2020-04-15","2020-04-15","2020-04-15","2020-04-15"],"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":[["","23155050105","HYDROXYZ","TAB 25MG","60","Select","Select",""],["","42806040021","METHYLPRED","TAB 4MG","21","Select","Select",""],["","67877043203","ARIPIPRAZOLE","TAB 10MG","30","Select","Select",""],["","43598029590","PREGABALIN","CAP 150MG","60","Select","Select",""],["","00172392670","DIAZEPAM","TAB 5MG","3","Select","Select",""],["","55111012205","ATORVASTATIN","TAB 20MG","90","Select","Select",""],["","00093031401","KETOROLAC","TAB 10MG","20","Select","Select",""],["","65162062711","TRAMADOL","TAB 50MG","60","Select","Select",""],["","52817033200","CYCLOBENZAPR","TAB 10MG","20","Select","Select",""],["","00591544305","PREDNISONE","TAB 20MG","5","Select","Select",""],["","31722099601","HYDROCO\/APAP","TAB 5-325MG","10","Select","Select",""],["","65862018601","CLINDAMYCIN","CAP 300MG","28","Select","Select",""],["","00406051205","OXYCOD\/APAP","TAB 5-325MG","12","Select","Select",""],["","00406055201","OXYCODONE","TAB 5MG","20","Select","Select",""],["","00378165993","SILDENAFIL","TAB 50MG","10","Select","Select",""],["","00378320501","PRAZOSIN","CAP 5MG","30","Select","Select",""],["","59267100001","PFIZER","INJ COVID-19","0","Select","Select",""],["","47335001083","TADALAFIL","TAB 5MG","30","Select","Select",""],["","65862049101","QUETIAPINE","TAB 100MG","60","Select","Select",""],["","00093005401","BUSPIRONE","TAB 10MG","90","Select","Select",""],["","65862001205","SERTRALINE","TAB 50MG","30","Select","Select",""],["","00378210001","LOPERAMIDE","CAP 2MG","30","Select","Select",""],["","68462019005","NAPROXEN","TAB 500MG","28","Select","Select",""],["","00172572860","FAMOTIDINE","TAB 20MG","20","Select","Select",""],["","65862090801","CELECOXIB","CAP 100MG","180","Select","Select",""],["","62175011843","OMEPRAZOLE","CAP 20MG","90","Select","Select",""],["","00143980305","DOXYCYCL","CAP 100MG","28","Select","Select",""],["","60505265401","TRAZODONE","TAB 100MG","30","Select","Select",""],["","00591352530","LIDOCAINE","PAD 0.05","30","Select","Select",""],["","64380080707","IBUPROFEN","TAB 800MG","60","Select","Select",""],["","69547035302","NARCAN","SPR ","2","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":""}]}]}