{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"FLOYD  O ALSTON","gend":0,"add":"2712 MYRTLE AVE","city":"NORFOLK","state":"VA","zip":"23504-9998","dob":"1959-10-20","age":"","mstatus":"","insh":"20038670*01","cliId":"","pno":7577765530,"cno":7577765530,"email":"","ename":"","eno":"","pphy":"TAYLOR, ALEX MD","ppno":7576230095,"pcpadd":"SUITE 1 1401 TIDEWATER AVE","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":"23504-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7576231203,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["B20.","I10.","H40.013","R97.20","B35.3","B35.1","M20.42","M20.41","H90.0","H61.23","Z23.","H72.92","N17.9","R10.84","E87.1","Z21.","H25.13","H35.62","H35.413","J40.","L60.8","N50.3","N50.811","N50.812","R39.89","K21.9","H90.A32","R09.81","J44.9","M21.611","M21.612","K57.32"],"date":["2023-03-08","2023-03-08","2022-12-12","2022-07-14","2022-08-26","2023-01-06","2023-01-06","2023-01-06","2021-04-07","2023-04-25","2021-12-01","2023-04-25","2022-06-29","2022-06-29","2022-06-29","2022-06-29","2022-08-18","2021-08-23","2022-08-18","2022-10-12","2022-05-20","2022-07-14","2022-07-14","2022-07-14","2022-07-14","2022-12-14","2021-10-13","2021-10-13","2021-02-15","2022-03-25","2023-01-06","2022-06-26"],"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":[["","57664037708","TRAMADOL HCL","50 MG","14","Select","Select",""],["","61958210101","ODEFSEY","200-25-25","30","Select","Select",""],["","00172572870","FAMOTIDINE","20 MG","30","Select","Select",""],["","16714085201","METOPROL SUC","TAB 25MG ER","30","Select","Select",""],["","69367016504","FERROUS GLUC","TAB 324MG","30","Select","Select",""],["","33332042010","AFLURIA QUAD","INJ 2020-21","0","Select","Select",""],["","00591352530","LIDOCAINE","5 %","30","Select","Select",""],["","42571016142","AMOX\/K CLAV","TAB 500-125","20","Select","Select",""],["","62332008190","VALSART\/HCTZ","TAB 160-25MG","30","Select","Select",""],["","29300015501","ALFUZOSIN","TAB 10MG ER","30","Select","Select",""],["","59267102504","PFIZER VACC","INJ ADLT RTU","0","Select","Select",""],["","51672129802","KETOCONAZOLE","2 %","30","Select","Select",""],["","42192071506","CICLOPIROX","8 %","6.6","Select","Select",""],["","58160082311","SHINGRIX","INJ 50\/0.5ML","1","Select","Select",""],["","00223176001","SOD CHLORIDE","TAB 1GM","15","Select","Select",""],["","42806071401","BENZONATATE","CAP 100MG","30","Select","Select",""],["","50111078751","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","70461032203","FLUCLVX QUAD","INJ 2022-23","0","Select","Select",""],["","00574050801","FERROUS GLUCONATE","324(38)MG","30","Select","Select",""],["","29300015519","ALFUZOSIN HCL ER","10 MG","30","Select","Select",""],["","55111015801","OMEPRAZOLE","20 MG","30","Select","Select",""],["","00574060801","FERROUS SULFATE","324(65)MG","30","Select","Select",""],["","16714085201","METOPROLOL SUCCINATE","25 MG","30","Select","Select",""],["","31722015390","VALSARTAN","160 MG","30","Select","Select",""],["","51672130104","AMMONIUM LACTATE","12 %","140","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":""}]}]}