{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ZION WILLIAMS","gend":0,"add":"PO BOX 962","city":"NASSAWADOX","state":"VA","zip":"23413-9998","dob":"2001-03-26","age":"","mstatus":"","insh":"20068406*01","cliId":"","pno":"757\/442-7799","cno":"757\/442-7799","email":"","ename":"","eno":"","pphy":"HOLLANDSWORTH, THOMAS MD","ppno":"757\/787-7374","pcpadd":"20306 BADGER LN","pcpcity":"ONLEY","pcpstate":"VA","pcpzip":23418,"pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/787-4513","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["V62.84","Z11.59","F28.","F91.8","F25.0","F25.1","F25.9","NO DATA","Z20.822","Z79.899","I10.","V62.85","R55.","R07.9","F20.9","Z23.","F41.9","R45.0","Z56.0","J30.9","R45.89","I49.9","G47.9","Z00.121","K59.00","J30.2","E66.1","E66.09","Z68.36","Z71.3","Z00.8","Z03.818","U07.1","E66.9","R50.9","Z68.39","R00.0","F32.9","R44.3","R21.","F51.04","E55.9","R30.0","Z13.89","H69.83","K30.","K21.9","F23.","R07.2","G89.29","F12.90","Z86.59"],"date":["2022-08-14","2020-10-09","2020-11-13","2022-02-20","2022-11-09","2022-09-29","2021-11-30","2022-03-14","2022-10-27","2022-08-14","2022-02-21","2022-10-27","2020-10-13","2021-01-08","2022-10-27","2022-02-18","2022-03-28","2022-03-28","2022-08-14","2021-01-08","2021-09-04","2020-09-07","2021-12-01","2022-04-04","2022-04-04","2022-04-04","2022-04-04","2022-04-04","2022-04-04","2022-04-04","2022-10-27","2020-12-10","2021-09-04","2022-02-20","2021-01-15","2021-03-31","2022-02-20","2022-02-20","2022-02-19","2020-10-03","2020-10-10","2020-10-10","2020-08-01","2020-08-01","2020-08-01","2020-10-10","2020-10-10","2021-01-06","2021-01-06","2021-01-06","2022-08-14","2022-08-14"],"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":[["","50458056401","INVEGA","INJ 234\/1.5","2","Select","Select",""],["","16714086801","PALIPERIDONE","TAB ER 6MG","30","Select","Select",""],["","00172392680","DIAZEPAM","TAB 5MG","90","Select","Select",""],["","00093585101","ESCITALOPRAM","TAB 10MG","30","Select","Select",""],["","69315013710","BENZTROPINE","TAB 1MG","60","Select","Select",""],["","57237000805","MIRTAZAPINE","TAB 15MG","30","Select","Select",""],["","69543038330","OLANZAPINE","TAB 10MG","30","Select","Select",""],["","60432026415","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","68382013905","TOPIRAMATE","TAB 50MG","30","Select","Select",""],["","45802065087","LORATADINE","TAB 10MG","90","Select","Select",""],["","57896048914","POLYETH","POW 3350 NF","238","Select","Select",""],["","62756018413","OXCARBAZEPIN","TAB 300MG","60","Select","Select",""],["","68382080510","TRAZODONE","TAB 50MG","30","Select","Select",""],["","68382007910","HALOPERIDOL","TAB 5MG","60","Select","Select",""],["","10006073040","MELATONIN","TAB 5MG","30","Select","Select",""],["","65862019405","FLUOXETINE","CAP 40MG","30","Select","Select",""],["","00168009915","KETOCONAZOLE","CRE 0.02","15","Select","Select",""],["","31722071390","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","69618000901","VITAMIN","CAP 2000UNIT","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":""}]}]}