{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DANIEL WHITE","gend":0,"add":"623 44TH ST","city":"NEWPORT NEWS","state":"VA","zip":"23607-9998","dob":"1960-10-25","age":"","mstatus":"","insh":"20058738*01","cliId":"","pno":7579150399,"cno":7579150399,"email":"","ename":"","eno":"","pphy":"WALKER, KEVA FNP","ppno":7573808709,"pcpadd":"4714 MARSHALL AVE,","pcpcity":"NEWPORT NEWS","pcpstate":"VA","pcpzip":"23607-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7579521345,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F10.20","F14.20","F31.11","B20.","Z23.","Z79.899","Z91.14","Z79.2","B37.0","I10.","F31.9","S05.01XA","S02.85XA","H53.141","S05.91XA","NO DATA","Z59.8","R19.7","R21.","Z28.310","H25.13","H04.123","H52.03","H52.4","Z91.148","H10.31","Z91.89"],"date":["2022-12-17","2021-10-20","2023-03-24","2023-09-01","2023-09-01","2023-09-01","2022-11-15","2022-11-15","2022-05-06","2021-12-20","2021-12-20","2021-11-28","2021-11-28","2021-11-28","2021-11-28","2022-11-15","2021-02-12","2022-05-06","2022-05-06","2022-05-06","2023-09-18","2023-09-18","2023-09-18","2023-09-18","2023-09-01","2023-09-01","2023-09-01"],"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":[["","49702022813","TIVICAY","50 MG","30","Select","Select",""],["","45802065065","LORATADINE","TAB 10MG","30","Select","Select",""],["","59676080030","SYMTUZA","800-150 MG","30","Select","Select",""],["","65862042001","SMZ\/TMP DS","TAB 800-160","12","Select","Select",""],["","16729018201","HYDROCHLOROT","TAB 12.5MG","30","Select","Select",""],["","68382005101","MELOXICAM","TAB 15MG","30","Select","Select",""],["","68180035209","SERTRALINE","TAB 50MG","30","Select","Select",""],["","55111015830","OMEPRAZOLE","CAP 20MG","30","Select","Select",""],["","61314062810","POLYMYXIN B\/","SOL TRIMETHP","10","Select","Select",""],["","16714047802","AMOX\/K CLAV","TAB 875-125","20","Select","Select",""],["","66689000816","NYSTATIN","SUS 100000","240","Select","Select",""],["","68462010430","FLUCONAZOLE","TAB 200MG","21","Select","Select",""],["","80777027399","MODERNA VAC","INJ COVID-19","0","Select","Select",""],["","49281042150","FLUZONE QUAD","INJ 2021-22","0","Select","Select",""],["","00093031101","LOPERAMIDE","CAP 2MG","30","Select","Select",""],["","16729008110","NALTREXONE","TAB 50MG","30","Select","Select",""],["","65862042001","SULFAMETHOXAZOLE-TRIMETHOPRIM","800-160 MG","12","Select","Select",""],["","68462010430","FLUCONAZOLE TAB","200MG","21","Select","Select",""],["","65862042001","SMZ\/TMP DS TAB","800-160","12","Select","Select",""],["","45802065065","LORATADINE TAB","10MG","30","Select","Select",""],["","49702022813","TIVICAY TAB","50MG","30","Select","Select",""],["","59676080030","SYMTUZA TAB","","30","Select","Select",""],["","00228282011","HYDROCHLOROT TAB","12.5MG","30","Select","Select",""],["","68180035209","SERTRALINE TAB","50MG","30","Select","Select",""],["","68382005101","MELOXICAM TAB","15MG","30","Select","Select",""],["","49281042150","FLUZONE QUAD INJ","2021-22","0","Select","Select",""],["","80777027399","MODERNA VAC INJ COVID-","19","0","Select","Select",""],["","00378210001","LOPERAMIDE CAP","2MG","30","Select","Select",""],["","66689000816","NYSTATIN SUS","100000","240","Select","Select",""],["","16729008110","NALTREXONE TAB","50MG","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":""}]}]}