{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TRACY  M HOLLIMAN","gend":1,"add":"920 CHUMLEY RD APT D","city":"PORTSMOUTH","state":"VA","zip":"23701-9998","dob":"1981-10-20","age":"","mstatus":"","insh":"1491893*01","cliId":"","pno":7575560403,"cno":7575560403,"email":"","ename":"","eno":"","pphy":"ABDELSHAHEED, SAMIR T MD","ppno":7574883333,"pcpadd":"3925 PORTSMOUTH BLVD,","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":"23321-9998","pcpcounty":"","pcpid":"","pcpname":"Family Medicine Healthcare, PLLC","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7574880007,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["D50.0","N92.0","D72.819","K90.9","R10.2","B97.7","D64.9","D70.9","D50.9","Z01.419","Z12.4","Z11.51","N76.0","K81.0","I10.","K80.10","Z20.828","R10.9","N89.8","Z11.3","M54.2","R82.90","R87.810","N87.0","Z30.011","Z11.4","B37.3"],"date":["2022-03-25","2022-04-04","2022-03-04","2022-03-25","2022-03-21","2021-07-26","2021-09-03","2021-09-03","2022-04-12","2021-06-29","2021-06-29","2021-06-29","2022-02-01","2022-12-27","2022-12-27","2022-12-27","2021-09-14","2022-05-17","2022-06-13","2022-06-13","2021-07-30","2022-04-04","2021-08-11","2022-03-21","2021-08-11","2021-11-24","2021-11-24"],"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":[["","29300022705","METRONIDAZOL TAB","500MG","14","Select","Select",""],["","00781707787","METRONIDAZOL GEL","0.75%VAG","70","Select","Select",""],["","59762005601","MEDROXYPR AC TAB","10MG","90","Select","Select",""],["","68180098103","LISINOPRIL TAB","20MG","30","Select","Select",""],["","68462015713","ONDANSETRON TAB","4MG ODT","3","Select","Select",""],["","68462019005","NAPROXEN TAB","500MG","28","Select","Select",""],["","27241021601","CHLORTHALID TAB","25MG","30","Select","Select",""],["","68382009705","PAROXETINE TAB","10MG","30","Select","Select",""],["","65862042005","SMZ\/TMP DS TAB","800-160","6","Select","Select",""],["","00406012305","HYDROCO\/APAP TAB","5-325MG","15","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":""}]}]}