{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"EBONIE   R GREGORY","gend":1,"add":"55 GRADY ST APT 20","city":"CHESAPEAKE","state":"VA","zip":"23324-9998","dob":"1987-12-20","age":"","mstatus":"","insh":"3642569*01","cliId":"","pno":"757\/320-6570","cno":"","email":"","ename":"","eno":"","pphy":"WHALEN, RICHARD M MD","ppno":"757\/446-5955","pcpadd":"SUITE 118 825 FAIRFAX AVE","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23507,"pcpcounty":"","pcpid":"","pcpname":"EVMS Ghent Family Medicine","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/446-5242","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J03.00","Z01.419","Z32.02","Z30.42","I82.403","D68.59","R10.2","N39.0","R87.610","R87.810","Z71.89","I10.","I82.541","I87.2","Z86.718","R51.9","E55.9","E66.01","Z30.9","R03.0","L03.90","L90.5","L72.0","M54.6","N93.9","N30.01","Z32.01","L72.3","L08.9","D64.9","Z23.","Z68.41"],"date":["2020-04-27","2020-12-23","2020-12-23","2021-05-28","2021-02-01","2021-02-01","2020-11-21","2020-11-21","2021-06-17","2021-06-17","2021-06-17","2021-03-10","2021-02-01","2021-02-01","2021-02-01","2021-05-26","2021-03-10","2021-03-10","2021-03-10","2019-10-07","2019-10-07","2019-11-06","2019-11-06","2019-07-31","2019-07-31","2019-07-31","2019-07-31","2019-10-02","2019-10-02","2019-10-25","2019-10-25","2019-10-25"],"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":[["","","LISINOPRIL","TAB 10MG","","Select","Select",""],["","","FEROSUL"," FEROSUL ","30","Select","Select",""],["","11534018701","BUT\/APAP\/CAF","CAP ","10","Select","Select",""],["","","CEPHALEXIN"," CEPHALEXIN ","14","Select","Select",""],["","","APAP\/CODEINE"," APAP\/CODEINE ","12","Select","Select",""],["","","PRENATAL"," PRENATAL ","30","Select","Select",""],["","","TRETINOIN"," TRETINOIN ","45","Select","Select",""],["","","AZITHROMYCIN"," AZITHROMYCIN ","6","Select","Select",""],["","","SMZ\/TMP"," SMZ\/TMP ","14","Select","Select",""],["","","IBUPROFEN"," IBUPROFEN ","20","Select","Select",""],["","","HYDROCO\/APAP","TAB 7.5-325","","Select","Select",""],["","","CIPROFLOXACN","TAB 750MG","","Select","Select",""],["","","BP","MIS AUTOMATI","","Select","Select",""],["","","OXYCOD\/APAP","TAB 10-325MG","","Select","Select",""],["","","CHLORTHALID","TAB 25MG","","Select","Select",""],["","","PROMETHAZINE","TAB 12.5MG","","Select","Select",""],["","","CHLORHEX","SOL 0.0012","","Select","Select",""],["","","AMOXICILLIN","CAP 500MG","","Select","Select",""],["","","VITAMIN","CAP 50000UNT","","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":""}]}]}