{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TONY STATON","gend":0,"add":"1408 WENDFIELD DR APT 101","city":"VIRGINIA BEACH","state":"VA","zip":"23453-9998","dob":"1966-04-21","age":"","mstatus":"","insh":"20039705*01","cliId":"","pno":7574700548,"cno":7574700548,"email":"","ename":"","eno":"","pphy":"ORLINO, ROBERT MD","ppno":7574253610,"pcpadd":"940 GENERAL BOOTH BLVD STE A","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":"23451-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7574223714,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F25.0","F14.20","F10.20","F10.10","F14.10","M25.551","M25.552","M87.859","F43.10","E11.9","I10.","J44.9","I67.89","Z13.0","Z13.220","Z13.29","Z13.228","Z12.11","Z12.5","M25.559","F25.1"],"date":["2023-04-16","2022-12-20","2023-04-11","2023-03-30","2023-03-30","2023-03-21","2023-03-21","2023-03-21","2023-03-29","2023-02-17","2023-02-17","2023-02-17","2022-09-12","2022-09-12","2022-09-12","2022-09-12","2022-09-12","2022-09-12","2022-09-12","2023-02-17","2022-07-31"],"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":[["","13668033005","TRAZODONE","TAB 50MG","30","Select","Select",""],["","31722082830","ARIPIPRAZOLE","15 MG","30","Select","Select",""],["","00093506201","HYDROXYZ HCL","TAB 50MG","60","Select","Select",""],["","53885024450","ONETOUCH","TES ULTRA","50","Select","Select",""],["","53885000810","ONETOUCH DEL","MIS PLUS 33G","100","Select","Select",""],["","21292000616","TRUE METRIX","TES GLUCOSE","100","Select","Select",""],["","00378456177","POT CHLORIDE","TAB 10MEQ ER","60","Select","Select",""],["","43547035610","LISINOPRIL","40 MG","90","Select","Select",""],["","11822316910","RA ASPIRIN","TAB 81MG EC","30","Select","Select",""],["","16729018201","HYDROCHLOROT","TAB 12.5MG","30","Select","Select",""],["","00378003210","METOPROL TAR","TAB 50MG","60","Select","Select",""],["","29300039805","AMLODIPINE","TAB 10MG","30","Select","Select",""],["","00310737020","BUDES\/FORMOT","AER 160-4.5","10","Select","Select",""],["","67877056105","METFORMIN","TAB 500MG","120","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","17","Select","Select",""],["","00186037020","SYMBICORT","AER 160-4.5","10","Select","Select",""],["","69315013601","BENZTROPINE","TAB 0.5MG","30","Select","Select",""],["","00193654621","BAYER MICRLT","MIS LANCETS","100","Select","Select",""],["","68180046807","LOVASTATIN","TAB 20MG","60","Select","Select",""],["","68180063509","ATORVASTATIN","TAB 10MG","30","Select","Select",""],["","52817018000","CLONIDINE","TAB 0.1MG","20","Select","Select",""],["","00527058610","DICYCLOMINE","CAP 10MG","10","Select","Select",""],["","00115180301","HYDROXYZ PAM","CAP 25MG","15","Select","Select",""],["","00904678370","ASPIRIN LOW","TAB 81MG EC","30","Select","Select",""],["","00536132710","ACETAMINOPHE","TAB 325MG","60","Select","Select",""],["","00093216568","NALOXONE HCL","SPR 4MG","2","Select","Select",""],["","59651036005","IBUPROFEN","TAB 400MG","30","Select","Select",""],["","42799060501","LOPERAMIDE","CAP 2MG","10","Select","Select",""],["","00378456177","POTASSIUM CHLORIDE","10 MEQ","60","Select","Select",""],["","67877056105","METFORMIN HCL","500 MG","120","Select","Select",""],["","00093751731","FLUTICASONE-SALMETEROL","100-50 MCG","60","Select","Select",""],["","11822316910","ASPIRIN EC","81 MG","30","Select","Select",""],["","62332005531","CLONIDINE HCL","0.2 MG","60","Select","Select",""],["","65162062750","TRAMADOL HCL","50 MG","14","Select","Select",""],["","69315013601","BENZTROPINE MESYLATE","0.5 MG","30","Select","Select",""],["","70436001004","BUPROPION XL","150 MG","30","Select","Select",""],["","00173069500","ADVAIR DISKUS","100-50 MCG","60","Select","Select",""],["","66993001968","ALBUTEROL SULFATE HFA","90 MCG","18","Select","Select",""],["","43547034406","RISPERIDONE","4 MG","30","Select","Select",""],["","50111056001","TRAZODONE HCL","50 MG","30","Select","Select",""],["","00093506201","HYDROXYZINE HCL","50 MG","60","Select","Select",""],["","42806040021","METHYLPREDNISOLONE","4 MG","21","Select","Select",""],["","00228282011","HYDROCHLOROTHIAZIDE","12.5 MG","30","Select","Select",""],["","65862006301","METOPROLOL TARTRATE","50 MG","60","Select","Select",""],["","29300039805","AMLODIPINE BESYLATE","10 MG","30","Select","Select",""],["","00603548321","PROPRANOLOL HCL","20 MG","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":""}]}]}