{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ANTWAUN DANIELS","gend":0,"add":"180 DUPRE AVE UNIT 4","city":"NORFOLK","state":"VA","zip":"23503-9998","dob":"1976-08-17","age":"","mstatus":"","insh":"20064046*01","cliId":"","pno":7579493936,"cno":7579493936,"email":"","ename":"","eno":"","pphy":"GUNTHER, ALTHEA O MD","ppno":7574465955,"pcpadd":"825 FAIRFAX AVE SUITE 118,","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":"23507-9998","pcpcounty":"","pcpid":"","pcpname":"EVMS Ghent Family Medicine","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7574465196,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F60.89","F32.9","F41.1","F31.81","F43.10","F25.1","Z12.11","Z86.010","K63.5","F33.1","K62.5","I10.","F17.200","R35.0","R35.89","R79.89","M79.675","L84.","G44.201","V89.2XXA","Z01.812","Z20.822","R73.03","F31.9","R53.83","M54.2","NO DATA","G44.209","F43.9","M54.9","R41.3","K62.1","K64.8","K64.4","K44.9","K25.9","K29.60","D50.0","E11.9","E66.01","Z68.41","Z91.048","Z79.899","Z87.891","F43.12","Z71.6","Z01.810","K92.1","D64.9","Z79.1","Z71.3","F90.0","M79.671","Z01.818"],"date":["2023-08-08","2023-01-20","2023-08-22","2023-08-22","2023-08-22","2021-04-12","2023-05-12","2021-02-03","2023-05-12","2021-05-18","2023-05-12","2022-09-30","2021-06-23","2022-03-10","2023-05-12","2022-03-10","2022-05-23","2022-05-23","2023-06-01","2023-06-01","2021-09-10","2021-09-10","2022-09-30","2022-09-30","2022-09-30","2023-07-06","2023-07-06","2023-07-06","2021-04-14","2021-04-21","2021-04-21","2021-09-13","2021-09-13","2021-09-13","2021-09-13","2021-09-13","2021-09-13","2021-09-13","2021-09-13","2021-09-13","2021-09-13","2021-09-13","2021-09-13","2021-09-13","2022-07-15","2021-01-07","2021-01-30","2021-07-27","2021-08-11","2021-08-11","2021-08-11","2023-08-22","2022-04-25","2021-09-06"],"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":[["","16729013212","QUETIAPINE TAB","50MG ER","60","Select","Select",""],["","51672413204","LAMOTRIGINE TAB","150MG","30","Select","Select",""],["","68180035306","SERTRALINE TAB","100MG","45","Select","Select",""],["","80681017400","VITAMIN D","3 CAP 50000UNT","4","Select","Select",""],["","80777027399","MODERNA VAC INJ COVID-","19","0","Select","Select",""],["","69238134201","ETODOLAC TAB","400MG","20","Select","Select",""],["","67877021901","CEPHALEXIN CAP","500MG","14","Select","Select",""],["","54092038501","ADDERALL XR CAP","15MG","30","Select","Select",""],["","00228306311","AMPHET\/DEXTR CAP","15MG ER","30","Select","Select",""],["","51672413204","LAMOTRIGINE","150 MG","30","Select","Select",""],["","16729013212","QUETIAPINE FUMARATE ER","50 MG","60","Select","Select",""],["","69097083512","SERTRALINE HCL","100 MG","45","Select","Select",""],["","68180035306","SERTRALINE","TAB 100MG","45","Select","Select",""],["","16729013212","QUETIAPINE","TAB 50MG ER","60","Select","Select",""],["","80681017400","VITAMIN D3","CAP 50000UNT","4","Select","Select",""],["","80777027399","MODERNA VAC","INJ COVID-19","0","Select","Select",""],["","67877021901","CEPHALEXIN","CAP 500MG","14","Select","Select",""],["","00228306311","AMPHET\/DEXTR","CAP 15MG ER","30","Select","Select",""],["","69238134201","ETODOLAC","TAB 400MG","20","Select","Select",""],["","54092038501","ADDERALL XR","CAP 15MG","30","Select","Select",""],["","57237002801","AMOXICILLIN","500 MG","21","Select","Select",""],["","65162046550","IBUPROFEN","600 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":""}]}]}