{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ORIEL   P LEE","gend":1,"add":"2577 MERRY POINT ROAD","city":"LANCASTER","state":"VA","zip":"22503-9998","dob":"1989-05-01","age":"","mstatus":"","insh":"6759211*01","cliId":"","pno":"804\/724-3282","cno":"","email":"","ename":"","eno":"","pphy":"FAULKNER, LINDSEY D NP","ppno":"804\/435-2651","pcpadd":"402 N MAIN ST","pcpcity":"KILMARNOCK","pcpstate":"VA","pcpzip":22482,"pcpcounty":"","pcpid":"","pcpname":"CHESAPEAKE HOSPITAL LLC","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/435-2302","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z30.9","Z11.3","Z32.02","F14.10","R06.02","R51.","Z20.828","F31.9","F32.0","F31.31","D49.2","Z68.29","B34.9","R11.2","R19.7","F41.1","F43.12","R03.0","R53.83","F51.09","F17.200","J06.9","R05.","B97.89","Z72.0","F10.239","F31.5","V62.84","F17.210","E55.9","Z62.811","Z91.411","Z01.419","F41.8"],"date":["2020-01-13","2020-01-13","2020-01-13","2020-09-28","2020-08-18","2020-08-18","2020-08-18","2021-10-20","2021-10-20","2021-10-20","2021-10-20","2021-10-20","2020-01-02","2020-01-02","2020-01-02","2020-07-09","2020-10-28","2019-08-26","2019-08-26","2019-08-26","2019-08-26","2019-12-12","2019-12-12","2019-12-12","2019-12-12","2019-08-25","2019-08-25","2019-08-25","2019-08-25","2019-08-25","2019-08-25","2019-08-25","2019-07-18","2019-07-18"],"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":[["","","PAROXETINE","TAB 20MG","","Select","Select",""],["","","BUSPIRONE","TAB 10MG","","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","21","Select","Select",""],["","50111043301","TRAZODONE","TAB 50MG","14","Select","Select",""],["","43547034206","RISPERIDONE","TAB 2MG","14","Select","Select",""],["","65162019050","NAPROXEN","TAB 500MG","20","Select","Select",""],["","14539067501","HYDROXYZ","CAP 50MG","56","Select","Select",""],["","63402030230","LATUDA","TAB 20MG","14","Select","Select",""],["","","HYDROCHLOROT","TAB 25MG","","Select","Select",""],["","","IBUPROFEN","TAB 800MG","","Select","Select",""],["","","PRAZOSIN","CAP 1MG","","Select","Select",""],["","","LOPERAMIDE","CAP 2MG","","Select","Select",""],["","","PROMETHAZINE","TAB 25MG","","Select","Select",""],["","","ACAMPRO","TAB 333MG","","Select","Select",""],["","","HYDROCO\/APAP","TAB 5-325MG","","Select","Select",""],["","69097083412","SERTRALINE","TAB 50MG","30","Select","Select",""],["","16729008110","NALTREXONE","TAB 50MG","14","Select","Select",""],["","00536354701","DAILY-VITE","TAB ","14","Select","Select",""],["","58487003711","VITAMIN","TAB 2000UNIT","14","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":""}]}]}