{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TYRONE HOLLOMAN","gend":0,"add":"5124 HAIR ROAD","city":"PETERSBURG","state":"VA","zip":"23803-9998","dob":"1985-03-26","age":"","mstatus":"","insh":"1628743*01","cliId":"","pno":8042299918,"cno":8042299918,"email":"","ename":"","eno":"","pphy":"QUARSHIE, GEORGE MD","ppno":"","pcpadd":"20901 CHESTERFIELD AVENUE,","pcpcity":"SOUTH CHESTERFIELD","pcpstate":"VA","pcpzip":"23803-9998","pcpcounty":"","pcpid":"","pcpname":"Bon Secours - South Chesterfield Family Medicine","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F10.21","F12.20","NO DATA","I11.9","F17.210","I10.","Z72.0","R53.81","F51.02","R53.83","Z28.21","Z87.448","Z68.27","F33.9","F33.1","F33.2","N34.2","Z71.6","L98.9","D17.23","Z91.199","F43.10"],"date":["2022-08-30","2022-08-30","2022-08-30","2022-12-28","2022-12-28","2022-12-28","2022-09-28","2022-12-28","2022-09-28","2022-12-28","2022-12-28","2022-09-28","2022-12-28","2022-07-10","2022-09-14","2022-08-28","2022-08-25","2022-12-28","2022-12-28","2022-12-28","2022-12-28","2022-09-14"],"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":[["","68180097903","LISINOPRIL TAB","40MG","90","Select","Select",""],["","68180072103","AMLODIPINE TAB","10MG","30","Select","Select",""],["","13107000130","MIRTAZAPINE TAB","7.5MG","30","Select","Select",""],["","00781809003","AZITHROMYCIN TAB","500MG","3","Select","Select",""],["","27808023302","DOXYCYCL HYC CAP","100MG","14","Select","Select",""],["","43598083105","ATORVASTATIN TAB","20MG","90","Select","Select",""],["","68180097903","LISINOPRIL","40 MG","90","Select","Select",""],["","75834025601","ATORVASTATIN CALCIUM","20 MG","30","Select","Select",""],["","68180072103","AMLODIPINE BESYLATE","10 MG","90","Select","Select",""],["","00781809003","AZITHROMYCIN","TAB 500MG","3","Select","Select",""],["","27808023302","DOXYCYCL HYC","CAP 100MG","14","Select","Select",""],["","68180072103","AMLODIPINE","TAB 10MG","30","Select","Select",""],["","13107000130","MIRTAZAPINE","TAB 7.5MG","30","Select","Select",""],["","43598083105","ATORVASTATIN","TAB 20MG","90","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":""}]}]}