{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ERICA CASTRO-MORRISON","gend":1,"add":"709 COCOWALK LN APT 107","city":"VIRGINIA BEACH","state":"VA","zip":"23462-9998","dob":"1983-02-12","age":"","mstatus":"","insh":"20069457*01","cliId":"","pno":"757\/535-0251","cno":"757\/535-0251","email":"","ename":"","eno":"","pphy":"BEELEY, SHANNON MURPHY NP-C","ppno":"800\/266-3853","pcpadd":"40 DUKE MEDICINE CIRCLE","pcpcity":"DURHAM","pcpstate":"NC","pcpzip":27710,"pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"919\/620-4921","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G89.4","M54.16","M47.816","M46.1","F41.9","M96.1","R19.7","R10.32","Z79.891","F41.1","M41.9","M19.90","D50.9","K31.89","K64.1","M25.559","G89.29","M54.5","Z76.0"],"date":["2021-05-10","2021-04-14","2021-05-10","2021-05-10","2020-10-07","2021-03-02","2021-01-28","2021-01-28","2021-05-10","2021-01-07","2021-08-16","2021-08-16","2021-01-28","2021-01-28","2021-01-28","2021-02-01","2021-06-14","2021-06-14","2021-06-14"],"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":[["","68382009601","HYDROXYCHLOR","TAB 200MG","180","Select","Select",""],["","68462012605","GABAPENTIN","TAB 600MG","60","Select","Select",""],["","75834002012","VITAMIN","CAP 50000UNT","4","Select","Select",""],["","00185094098","CHOLESTYRAM","POW 4GM","60","Select","Select",""],["","00527133001","BACLOFEN","TAB 10MG","90","Select","Select",""],["","00406012405","HYDROCO\/APAP","TAB 7.5-325","120","Select","Select",""],["","60505265301","TRAZODONE","TAB 50MG","60","Select","Select",""],["","00781106110","ALPRAZOLAM","TAB 0.25MG","90","Select","Select",""],["","27241009903","DULOXETINE","CAP 60MG","90","Select","Select",""],["","68382050010","OMEPRAZOLE","CAP 40MG","90","Select","Select",""],["","00591352530","LIDOCAINE","PAD 0.05","30","Select","Select",""],["","69547035302","NARCAN","SPR ","2","Select","Select",""],["","57237007710","ONDANSETRON","TAB 4MG ODT","10","Select","Select",""],["","10572010001","PEG-3350","SOL ELECTROL","4000","Select","Select",""],["","00527117001","DIPHEN\/ATROP","TAB 2.5MG","20","Select","Select",""],["","00143312610","DICYCLOMINE","CAP 10MG","28","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":""}]}]}