{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SHANA GILL","gend":1,"add":"133 MYTILENE DR","city":"NEWPORT NEWS","state":"VA","zip":"23605-9998","dob":"1975-08-08","age":"","mstatus":"","insh":"2303403*01","cliId":"","pno":"757\/877-8434","cno":"","email":"","ename":"","eno":"","pphy":"VALERIO, HERNANI A MD","ppno":"757\/930-0091","pcpadd":"12715 WARWICK BOULEVARD STE M O","pcpcity":"NEWPORT NEWS","pcpstate":"VA","pcpzip":23606,"pcpcounty":"","pcpid":"","pcpname":"Commonwealth Family Practice","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/269-4406","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F10.10","F41.9","F32.9","Z01.419","G47.9","R53.82","F41.8","R20.0","R20.2","I10.","NO DATA","F17.210","Z13.0","R74.8","R17.","K70.10","K21.9","R68.81","Z12.11","J20.9","Z20.822","A60.00","K59.00","S93.411A","M25.571","S93.491A","Z23.","S93.401A","Z91.81","E66.9","Z68.22","Z88.8","H93.293","R49.0","Z72.0","F17.200","E78.00","G56.22","U07.1","D64.9","E53.8","H91.93","K63.5","K57.30","K64.4","Z79.899","R27.0","K72.00"],"date":["2022-01-24","2020-11-18","2020-11-18","2021-08-17","2022-04-05","2022-04-05","2022-04-05","2022-05-31","2022-05-31","2022-06-08","2022-04-05","2022-06-08","2021-08-17","2022-01-24","2021-11-02","2022-04-05","2022-02-02","2022-02-02","2022-04-25","2022-04-13","2022-04-13","2021-06-24","2021-06-24","2022-06-16","2022-06-16","2022-06-16","2022-04-05","2022-06-08","2022-06-08","2022-06-08","2022-06-08","2022-06-08","2021-12-07","2021-12-07","2021-12-07","2022-04-25","2022-04-25","2022-07-08","2020-08-07","2022-04-05","2022-04-05","2022-04-05","2022-04-25","2022-04-25","2022-04-25","2022-04-25","2022-05-31","2021-06-20"],"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":[["","11917009215","FERROUS","TAB 325MG","90","Select","Select",""],["","65162010150","GABAPENTIN","CAP 100MG","90","Select","Select",""],["","54629006901","VITAMIN","TAB 250MG","90","Select","Select",""],["","11534016503","FOLIC","TAB 1MG","90","Select","Select",""],["","00904759082","FEROSUL","TAB 325MG","90","Select","Select",""],["","00121087316","LACTULOSE","SOL 10GM\/15","75","Select","Select",""],["","29300018701","BISOPRL\/HCTZ","TAB 2.5\/6.25","30","Select","Select",""],["","00378427577","VALACYCLOVIR","TAB 500MG","60","Select","Select",""],["","50111033402","METRONIDAZOL","TAB 500MG","14","Select","Select",""],["","57237007810","ONDANSETRON","TAB 8MG ODT","20","Select","Select",""],["","43547028910","BUPROPION","TAB 150MG SR","60","Select","Select",""],["","68382050010","OMEPRAZOLE","CAP 40MG","30","Select","Select",""],["","00115180401","HYDROXYZ","CAP 50MG","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":""}]}]}