{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DERRICK ASHLOCK","gend":0,"add":"409 BUTTERNUT CTS","city":"SUFFOLK","state":"VA","zip":"23434-9998","dob":"1983-06-04","age":"","mstatus":"","insh":"20073928*01","cliId":"","pno":7578093152,"cno":7578093152,"email":"","ename":"","eno":"","pphy":"MORRISON, WILLIAM PA","ppno":7579838600,"pcpadd":"114 N MAIN ST STE 200","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":7579343012,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N18.6","T82.898A","Z49.01","I13.2","I50.22","Z99.2","Z86.16","Z87.891","Z82.49","Z88.8","Z91.018","Z91.048","Z79.899","Z01.812","Z20.822","T82.9XXA","I10.","I51.7","Z56.0","N25.81","T82.868S","T82.858A","Z01.810","R94.31","Z53.8","E55.9","U07.1","Z01.818","I50.43","Z45.2","D68.9","V58.89","Z98.890","F41.8","H53.8","D63.1","I12.0","T82.868A","Z88.9","Z83.3","D63.8","Z76.89","E53.8","I50.23"],"date":["2023-03-06","2021-07-14","2022-08-29","2023-03-06","2022-08-29","2023-03-27","2022-08-29","2023-03-06","2022-08-29","2022-08-29","2022-08-29","2022-08-29","2022-08-29","2022-04-15","2022-04-15","2023-03-06","2023-03-27","2022-02-04","2022-01-21","2022-07-14","2022-01-21","2022-03-16","2022-04-15","2022-04-15","2021-03-29","2021-04-21","2021-10-19","2022-01-03","2022-04-18","2021-10-06","2023-03-27","2021-12-02","2022-02-04","2021-07-22","2021-07-22","2021-07-22","2022-02-21","2021-10-15","2021-10-15","2021-10-15","2021-06-09","2021-06-09","2021-06-09","2021-10-06"],"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":[["","68382052701","BUMETANIDE","TAB 2MG","60","Select","Select",""],["","31722052201","HYDRALAZINE","TAB 100MG","90","Select","Select",""],["","00406051201","OXYCOD\/APAP","TAB 5-325MG","30","Select","Select",""],["","43598047990","SEVELAMER","POW 2.4GM","90","Select","Select",""],["","13668010401","ISOSORB MONO","TAB 30MG ER","90","Select","Select",""],["","50383066730","LIDO\/PRILOCN","CRE 2.5-2.5%","30","Select","Select",""],["","29300013701","CLONIDINE","TAB 0.3MG","180","Select","Select",""],["","00761022120","VITAMIN B-12","TAB 1000 CR","90","Select","Select",""],["","31722070090","LOSARTAN POT","TAB 25MG","90","Select","Select",""],["","59528061601","RENAPLEX-D","TAB ","30","Select","Select",""],["","68382009505","CARVEDILOL","25 MG","60","Select","Select",""],["","49230064551","VELPHORO","500MG IRON","90","Select","Select",""],["","50383066730","LIDOCAINE-PRILOCAINE","2.5 %-2.5%","30","Select","Select",""],["","13668010401","ISOSORBIDE MONONITRATE ER","30 MG","90","Select","Select",""],["","29300013701","CLONIDINE HCL","0.3 MG","180","Select","Select",""],["","68645051554","AMLODIPINE BESYLATE","5 MG","30","Select","Select",""],["","43598036730","CINACALCET HCL","30 MG","30","Select","Select",""],["","31722052201","HYDRALAZINE HCL","100 MG","90","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":""}]}]}