{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JONATHAN D JOHNSON","gend":0,"add":"108 KILBY CT","city":"SUFFOLK","state":"VA","zip":"23434-9998","dob":"1963-12-15","age":"","mstatus":"","insh":"20063308*01","cliId":"","pno":7579343968,"cno":7579343968,"email":"","ename":"","eno":"","pphy":"WILLIAMS, MICHAEL MD","ppno":7579838600,"pcpadd":"#200 114 N MAIN ST","pcpcity":"SUFFOLK","pcpstate":"VA","pcpzip":"23434-9998","pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Internal Medicine Physicians - Downtown Suffolk","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7579341660,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E11.8","R06.02","F17.200","I10.","N40.0","F14.21","F33.1","D44.7","E11.65","R97.20","N40.1","N52.9","N13.8","F51.01","F43.12","F33.2","F25.1","R06.09","F17.210","Q35.9","R07.9","R39.11","E11.9","F17.218","N52.03","E78.2"],"date":["2022-07-05","2021-05-11","2021-04-09","2022-12-16","2021-07-14","2022-12-16","2022-12-16","2022-12-16","2022-07-05","2023-05-10","2021-11-10","2021-09-09","2021-09-09","2022-07-05","2023-05-04","2023-05-16","2023-05-23","2021-04-09","2021-04-09","2021-05-11","2021-05-11","2021-03-08","2021-11-10","2021-11-10","2021-11-10","2021-11-10"],"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":[["","00002751001","HUMALOG","INJ 100\/ML","60","Select","Select",""],["","08290328418","INSULIN SYRG","MIS 1ML\/31G","150","Select","Select",""],["","61874016030","VRAYLAR","6 MG","30","Select","Select",""],["","43547035410","LISINOPRIL","20 MG","90","Select","Select",""],["","65862016001","ZOLPIDEM","TAB 10MG","30","Select","Select",""],["","70436001004","BUPROPN HCL","TAB 150MG XL","30","Select","Select",""],["","53885001110","ONETOUCH DEL","MIS PLUS 30G","200","Select","Select",""],["","53885027210","ONETOUCH","TES VERIO","400","Select","Select",""],["","65862059805","TAMSULOSIN","CAP 0.4MG","90","Select","Select",""],["","82607066026","FLOWFLEX","KIT TEST","4","Select","Select",""],["","29300039805","AMLODIPINE","TAB 10MG","90","Select","Select",""],["","68180063609","ATORVASTATIN","TAB 20MG","90","Select","Select",""],["","11822511120","RA MELATONIN","TAB 5MG","60","Select","Select",""],["","00088222033","LANTUS","100\/ML","10","Select","Select",""],["","65162046510","IBUPROFEN","TAB 600MG","30","Select","Select",""],["","08290325773","BD LANCET UF","MIS 30G","200","Select","Select",""],["","69097083512","SERTRALINE HCL","100 MG","30","Select","Select",""],["","53885000810","ONETOUCH DELICA PLUS LANCET","33 GAUGE","100","Select","Select",""],["","53885024510","ONETOUCH ULTRA TEST STRIP","","400","Select","Select",""],["","29300039805","AMLODIPINE BESYLATE","10 MG","90","Select","Select",""],["","65862059805","TAMSULOSIN HCL","0.4 MG","90","Select","Select",""],["","65862016001","ZOLPIDEM TARTRATE","10 MG","30","Select","Select",""],["","70436001004","BUPROPION XL","150 MG","30","Select","Select",""],["","53885027210","ONETOUCH VERIO TEST STRIP","","100","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":""}]}]}