{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"EVELINE P HURT","gend":1,"add":"APT 205 PO BOX 1115","city":"VICTORIA","state":"VA","zip":"23974-9998","dob":"1977-06-08","age":"","mstatus":"","insh":"1067669*01","cliId":"","pno":4342653578,"cno":4342653578,"email":"","ename":"","eno":"","pphy":"MICHIE, DAVID W MD","ppno":4345842025,"pcpadd":"514 W ATLANTIC ST,","pcpcity":"SOUTH HILL","pcpstate":"VA","pcpzip":"23970-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":4344472240,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F25.1","E78.2","I11.0","I50.9","E78.5","Z82.49","Z87.891","E11.22","NO DATA","F31.9","J44.1","E11.65","Z68.41","Z28.21","I50.42","I42.9","I13.0","E66.01","R06.83","G47.30","I10.","E13.29","K76.9","R74.8","D68.9","Z28.20","R06.81","N18.4","Z71.3","Z71.82","F41.1","Z79.899","I50.22","E11.29","R07.9","E66.9","R06.02","I12.9","Z68.39","F31.75","F41.0","Z12.11"],"date":["2023-08-18","2023-09-14","2021-08-04","2021-08-04","2021-08-04","2021-08-04","2022-11-22","2023-09-05","2023-09-14","2022-12-07","2022-12-07","2023-09-05","2022-12-07","2022-12-07","2023-09-14","2023-09-14","2023-09-14","2023-09-14","2022-12-14","2022-12-14","2022-12-14","2021-12-06","2021-12-06","2021-12-06","2021-12-06","2021-12-06","2022-11-22","2022-11-22","2022-11-22","2022-11-22","2023-09-05","2022-07-28","2022-07-28","2022-09-21","2021-06-14","2021-06-14","2023-09-14","2023-09-05","2023-09-05","2023-09-05","2023-09-05","2023-09-05"],"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":[["","13668021990","ARIPIPRAZOLE","15 MG","30","Select","Select",""],["","68462026290","ROSUVASTATIN","TAB 10MG","90","Select","Select",""],["","16729022501","SPIRONOLACT","TAB 25MG","30","Select","Select",""],["","68382009405","CARVEDILOL","12.5 MG","180","Select","Select",""],["","68645061090","LISINOPRIL","10 MG","90","Select","Select",""],["","67877069601","CHLORTHALID","TAB 25MG","90","Select","Select",""],["","30768017621","VITAMIN D3","CAP 2000UNIT","90","Select","Select",""],["","59651026905","GLIPIZIDE ER","TAB 5MG","90","Select","Select",""],["","47781030301","NITROFURANTN","CAP 100MG","10","Select","Select",""],["","00597015230","JARDIANCE","TAB 10MG","30","Select","Select",""],["","68645058259","METFORMIN","TAB 500MG","90","Select","Select",""],["","74312017621","D3","CAP 50MCG","60","Select","Select",""],["","08290326895","BD SWAB REG","PAD SNGL USE","100","Select","Select",""],["","53885024510","ONETOUCH","TES ULTRA","100","Select","Select",""],["","00006022131","JANUVIA","TAB 25MG","30","Select","Select",""],["","53885000810","ONETOUCH DEL","MIS PLUS 33G","100","Select","Select",""],["","69097082212","CITALOPRAM HBR","10 MG","30","Select","Select",""],["","68462026290","ROSUVASTATIN CALCIUM","10 MG","90","Select","Select",""],["","53885024450","ONETOUCH ULTRA TEST STRIP","","50","Select","Select",""],["","53885000810","ONETOUCH DELICA PLUS LANCET","33 GAUGE","100","Select","Select",""],["","53746051101","SPIRONOLACTONE","25 MG","90","Select","Select",""],["","67877069601","CHLORTHALIDONE","25 MG","90","Select","Select",""],["","67877069601","CHLORTHALID TAB","25MG","90","Select","Select",""],["","68382009405","CARVEDILOL TAB","12.5MG","180","Select","Select",""],["","16729022501","SPIRONOLACT TAB","25MG","90","Select","Select",""],["","65162089903","ARIPIPRAZOLE TAB","15MG","30","Select","Select",""],["","74312017621","D","3 CAP 50MCG","60","Select","Select",""],["","16714098901","ROSUVASTATIN TAB","10MG","90","Select","Select",""],["","68645055254","LISINOPRIL TAB","10MG","90","Select","Select",""],["","53885004601","ONETOUCH KIT ULTRA","2","1","Select","Select",""],["","08290326895","BD SWAB REG PAD SNGL USE","","100","Select","Select",""],["","53885024510","ONETOUCH TES ULTRA","","100","Select","Select",""],["","00597015230","JARDIANCE TAB","10MG","30","Select","Select",""],["","53885000810","ONETOUCH DEL MIS PLUS","33G","100","Select","Select",""],["","00006022131","JANUVIA TAB","25MG","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":""}]}]}