{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"EMMA   I FLORES","gend":1,"add":"5000 CONDUIT ROAD","city":"COLONIAL HEIGHTS","state":"VA","zip":"23834-9998","dob":"1957-07-02","age":"","mstatus":"","insh":"20068863*01","cliId":"","pno":"804\/720-4126","cno":"","email":"","ename":"","eno":"","pphy":"LEWIS, JOHN DO","ppno":"","pcpadd":"436 CLAIRMONT COURT SUITE 100","pcpcity":"COLONIAL HEIGHTS","pcpstate":"VA","pcpzip":23834,"pcpcounty":"","pcpid":"","pcpname":"SOUTHSIDE PHYSICIANS NETWORK - FAMILY MEDICINE","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J32.9","E11.9","E21.3","E66.01","Z68.41","M17.11","E66.9","R07.9","R06.09","E78.2","R53.83","I10.","N39.0","E03.9","E78.5","Z79.84","Z79.82","R30.0","Z12.11","K63.5","R51.9","Z20.828","R07.0","R87.9","R94.39","H25.13","D12.2","R43.8","J34.89","J34.2","M94.0","N30.01","Z68.35","M19.90","Z68.36","Z20.822","B37.3","H69.81","I25.10"],"date":["2021-01-20","2021-12-07","2021-07-21","2021-12-07","2021-07-21","2020-10-14","2020-10-14","2021-12-07","2021-01-06","2021-12-07","2021-12-07","2021-12-07","2021-10-14","2021-10-14","2021-10-14","2021-10-14","2021-10-14","2021-11-24","2020-11-03","2020-11-03","2020-11-24","2020-11-24","2020-11-24","2020-11-24","2020-12-16","2021-01-08","2020-11-03","2021-04-14","2021-04-14","2021-04-14","2021-12-07","2021-11-24","2021-11-24","2020-11-03","2020-11-03","2021-12-20","2021-10-31","2021-09-27","2021-07-21"],"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":[["","","PNEUMOVAX","INJ 25\/0.5","","Select","Select",""],["","","CALCIUM\/D3","TAB 600-400","","Select","Select",""],["","53885027150","ONETOUCH","TES VERIO","50","Select","Select",""],["","","METFORMIN","TAB 500MG ER","","Select","Select",""],["","60505083305","AZELASTINE","SPR 0.001","30","Select","Select",""],["","","ATORVASTATIN","TAB 40MG","","Select","Select",""],["","","LEVOTHYROXIN","TAB 50MCG","","Select","Select",""],["","","FLUCLVX","INJ 2020-21","","Select","Select",""],["","","CARVEDILOL","TAB 6.25MG","","Select","Select",""],["","47781030301","NITROFURANTN","CAP 100MG","10","Select","Select",""],["","59267100003","PFIZER","INJ COVID-19","0","Select","Select",""],["","31604002673","D3","TAB 2000UNIT","30","Select","Select",""],["","","LOSARTAN","TAB 100MG","","Select","Select",""],["","","NITROGLYCER","DIS 0.2MG\/HR","","Select","Select",""],["","","CALCIUM\/D","TAB 600-400","","Select","Select",""],["","65862056099","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","00597015230","JARDIANCE","TAB 10MG","90","Select","Select",""],["","00781261305","AMOXICILLIN","CAP 500MG","30","Select","Select",""],["","65702072910","ACCU-CHEK","KIT GUIDE","1","Select","Select",""],["","50924097110","SOFTCLIX","MIS LANCETS","100","Select","Select",""],["","67877021905","CEPHALEXIN","CAP 500MG","14","Select","Select",""],["","55111014512","FLUCONAZOLE","TAB 150MG","2","Select","Select",""],["","80681013200","VITAMIN","TAB 50MCG","90","Select","Select",""],["","","PEG-3350\/KCL","SOL \/SODIUM","","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":""}]}]}