{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DERRELL  L WASHINGTON","gend":0,"add":"2931 ARGONNE AVE","city":"NORFOLK","state":"VA","zip":"23509-9998","dob":"1967-01-11","age":"","mstatus":"","insh":"20036974*01","cliId":"","pno":7577143087,"cno":7577143087,"email":"","ename":"","eno":"","pphy":"DONALDSON, NICOLE MD","ppno":7572276866,"pcpadd":"SUITE 504 301 RIVERVIEW AVENUE","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":"23510-9998","pcpcounty":"","pcpid":"","pcpname":"Fort Norfolk Plaza Primary Care","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7572770298,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["C90.00","E87.6","R51.9","Z79.899","G47.33","G25.81","G47.00","G47.50","U07.1","I10.","E11.9","M79.674","B35.1","L60.0","H40.1134","H25.13","H16.223","I67.4","M25.522","F52.8","N17.9","K52.9","Z20.822","Z99.89","K21.9","H40.022","M54.9","M62.830","R19.7","M54.5","N64.4","N52.8","R97.20","M25.512","H40.023","R53.83","H40.1124","M79.671","M79.672","M21.41","M21.42","M72.2","E11.40"],"date":["2023-02-23","2022-10-20","2022-10-20","2021-03-25","2022-12-01","2022-10-27","2022-10-27","2022-10-27","2021-02-16","2022-10-13","2023-03-01","2022-10-20","2023-04-20","2023-04-20","2023-03-02","2023-03-02","2023-03-02","2022-01-04","2022-01-04","2022-01-04","2022-09-24","2022-09-22","2022-09-22","2022-09-22","2022-10-13","2022-11-29","2021-07-09","2021-07-09","2022-10-20","2021-07-16","2021-09-09","2023-04-07","2022-10-25","2023-02-23","2023-03-01","2022-10-20","2023-03-31","2023-04-20","2023-04-20","2023-04-20","2023-04-20","2023-04-20","2023-04-20"],"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":[["","59572041028","REVLIMID","10 MG","28","Select","Select",""],["","00378668977","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","59762033302","LATANOPROST","SOL 0.00005","2","Select","Select",""],["","66685100100","AMOX\/K CLAV","TAB 875-125","20","Select","Select",""],["","68382091634","METHYLPRED","TAB 4MG","21","Select","Select",""],["","75834002012","VITAMIN D3","CAP 50000UNT","4","Select","Select",""],["","69543025216","VIRTUSSIN AC","SOL 100-10\/5","300","Select","Select",""],["","00406055201","OXYCODONE","TAB 5MG","26","Select","Select",""],["","53885001110","ONETOUCH DEL","MIS PLUS 30G","100","Select","Select",""],["","53885027150","ONETOUCH","TES VERIO","50","Select","Select",""],["","00378456105","POT CHLORIDE","TAB 10MEQ ER","90","Select","Select",""],["","65862018830","ONDANSETRON","TAB 8MG","30","Select","Select",""],["","29300012810","HYDROCHLOROT","TAB 25MG","90","Select","Select",""],["","60505014102","GLIPIZIDE","TAB 5MG","60","Select","Select",""],["","68180097903","LISINOPRIL","40 MG","30","Select","Select",""],["","57664047758","METOPROL TAR","TAB 50MG","60","Select","Select",""],["","70954005920","PREDNISONE","TAB 10MG","26","Select","Select",""],["","65162062711","TRAMADOL HCL","TAB 50MG","28","Select","Select",""],["","55111018015","TIZANIDINE","TAB 4MG","540","Select","Select",""],["","50742062001","NIFEDIPINE","TAB 30MG ER","30","Select","Select",""],["","70710146707","COLESTIPOL","TAB 1GM","120","Select","Select",""],["","31722064430","TADALAFIL","TAB 5MG","30","Select","Select",""],["","00378668977","PANTOPRAZOLE SODIUM","40 MG","90","Select","Select",""],["","70710146707","COLESTIPOL HCL","1 G","120","Select","Select",""],["","00406055201","OXYCODONE HCL","5 MG","26","Select","Select",""],["","64980051405","TIMOLOL MALEATE","0.5 %","5","Select","Select",""],["","60505100301","KETOROLAC TROMETHAMINE","0.5 %","5","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":""}]}]}