{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ARCHIE   L GREENE","gend":0,"add":"3240 WHITE MARSH ROAD","city":"SUFFOLK","state":"VA","zip":"23434-9998","dob":"1979-07-11","age":"","mstatus":"","insh":"2289831*01","cliId":"","pno":"757\/934-7786","cno":"757\/934-7786","email":"","ename":"","eno":"","pphy":"GREER, STEVEN P MD","ppno":"757\/923-1060","pcpadd":"2019 MEADE PARKWAY","pcpcity":"SUFFOLK","pcpstate":"VA","pcpzip":23434,"pcpcounty":"","pcpid":"","pcpname":"Select Specialty Hospital","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","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":["R03.0","R12.","E78.2","E66.09","Z23.","E11.65","G47.33","Z68.35","I10.","Z00.00","E08.9","R00.0","Z79.4","K63.89","E11.9","D31.32","H04.123","J06.9","U07.1","R05.9","Z87.891","R10.9","Z01.00","E10.9","H10.45","K76.0"],"date":["2021-01-14","2022-08-23","2022-08-23","2021-01-14","2021-01-14","2022-07-04","2022-01-31","2021-01-14","2022-09-21","2022-08-23","2022-08-23","2022-08-23","2022-08-23","2022-09-21","2022-09-21","2022-01-07","2022-01-07","2022-01-17","2022-05-03","2022-05-03","2022-09-21","2022-09-21","2020-04-23","2020-11-04","2020-11-04","2020-06-10"],"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":[["","08496320801","EASY","MIS 32GX5\/32","200","Select","Select",""],["","42806071501","BENZONATATE","CAP 200MG","30","Select","Select",""],["","00169406013","VICTOZA","INJ 18MG\/3ML","9","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","65862020199","LOSARTAN","TAB 25MG","30","Select","Select",""],["","55111012305","ATORVASTATIN","TAB 40MG","90","Select","Select",""],["","68382050010","OMEPRAZOLE","CAP 40MG","90","Select","Select",""],["","65862076890","FENOFIBRATE","TAB 48MG","30","Select","Select",""],["","62088000031","INPEN","MIS BLUE","1","Select","Select",""],["","00088221905","LANTUS","INJ 100\/ML","18","Select","Select",""],["","00378718705","METFORMIN","TAB 1000MG","180","Select","Select",""],["","73070010315","INSULIN","INJ FLEXPEN","15","Select","Select",""],["","00169633910","NOVOLOG","INJ FLEXPEN","15","Select","Select",""],["","08222095459","PEN  NEEDLES","MIS 32GX4MM","200","Select","Select",""],["","51293084405","IBUPROFEN","TAB 600MG","24","Select","Select",""],["","65862018730","ONDANSETRON","TAB 4MG","8","Select","Select",""],["","72606057103","PIOGLITAZONE","TAB 30MG","24","Select","Select",""],["","00597015330","JARDIANCE","TAB 25MG","30","Select","Select",""],["","68180096301","ALBUTEROL","AER HFA","8","Select","Select",""],["","00006483703","PNEUMOVAX","INJ 25\/0.5","0","Select","Select",""],["","53885001110","ONETOUCH","MIS PLUS 30G","300","Select","Select",""],["","11917006843","GLUCOSE","CHW 4GM","90","Select","Select",""],["","08290320550","BD  PEN NEEDL","MIS 32GX5\/32","300","Select","Select",""],["","57599080300","FREESTY","MIS 2 READER","1","Select","Select",""],["","13668009205","PRAMIPEXOLE","TAB 0.25MG","30","Select","Select",""],["","59267100001","PFIZER","INJ COVID-19","0","Select","Select",""],["","00006057561","JANUMET","TAB 50-500MG","60","Select","Select",""],["","00193731221","CONTOUR","TES NEXT","100","Select","Select",""],["","00002143380","TRULICITY","INJ 0.75\/0.5","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":""}]}]}