{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MILLARD L BRANCH","gend":0,"add":"1016 HOLLADAY ST","city":"PORTSMOUTH","state":"VA","zip":"23704-9998","dob":"1977-01-16","age":"","mstatus":"","insh":"2174643*01","cliId":"","pno":7575377956,"cno":7575377956,"email":"","ename":"","eno":"","pphy":"SMITH, MARGO NP","ppno":7577381600,"pcpadd":"2613 TAYLOR RD SUITE 201,","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":"23321-9998","pcpcounty":"","pcpid":"","pcpname":"Bon Secours Western Branch Primary Care","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7574658616,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["B20.","R73.03","NO DATA","B59.","Z23.","E66.9","G47.33","Z11.59","Z11.3","R10.11","K81.1","R07.9","E78.5","Z68.30","R13.10","R10.13","R14.2","K21.9","Z20.828","R19.7","R09.82","E78.2","Z68.31","K80.10","J02.9","R05.9","I49.3","M54.42","G89.29","R12.","R07.89","K42.9","J30.9","Z87.891","J06.9"],"date":["2022-08-25","2022-08-25","2022-08-25","2022-08-25","2022-08-25","2022-08-25","2022-08-25","2022-08-25","2022-08-25","2022-08-25","2021-11-11","2021-03-18","2021-03-11","2021-03-11","2021-09-03","2021-12-07","2021-09-03","2021-09-03","2022-04-08","2022-04-08","2022-04-08","2022-05-03","2021-06-22","2021-11-11","2022-05-03","2022-05-03","2021-11-05","2022-04-15","2022-04-15","2021-02-12","2021-03-18","2021-10-12","2022-04-15","2022-04-15","2022-04-26"],"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":[["","61958190101","GENVOYA","150-200-10","30","Select","Select",""],["","00093505698","ATORVASTATIN","TAB 10MG","90","Select","Select",""],["","13668042905","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","81131009371",""," ","60","Select","Select",""],["","29300041519","CYCLOBENZAPR","TAB 10MG","30","Select","Select",""],["","59746000103","METHYLPRED","TAB 4MG","21","Select","Select",""],["","29300022019","MONTELUKAST","TAB 10MG","90","Select","Select",""],["","60505082601","IPRATROPIUM","SPR 0.0003","30","Select","Select",""],["","72205002790","ROSUVASTATIN","TAB 5MG","30","Select","Select",""],["","81131009371","IRON","325(65) MG","60","Select","Select",""],["","16714008210","HYDROXYZ HCL","TAB 25MG","30","Select","Select",""],["","00904759080","FEROSUL","325(65) MG","60","Select","Select",""],["","81131009371","SV IRON","TAB 325MG","60","Select","Select",""],["","72205002799","ROSUVASTATIN CALCIUM","5 MG","90","Select","Select",""],["","29300041519","CYCLOBENZAPRINE HCL","10 MG","30","Select","Select",""],["","61958190101","GENVOYA TAB","","30","Select","Select",""],["","00093505698","ATORVASTATIN TAB","10MG","90","Select","Select",""],["","13668042905","PANTOPRAZOLE TAB","40MG","30","Select","Select",""],["","29300041519","CYCLOBENZAPR TAB","10MG","30","Select","Select",""],["","42806040021","METHYLPRED TAB","4MG","21","Select","Select",""],["","29300022019","MONTELUKAST TAB","10MG","30","Select","Select",""],["","72205002790","ROSUVASTATIN TAB","5MG","90","Select","Select",""],["","60505082601","IPRATROPIUM SPR","0.03%","30","Select","Select",""],["","31604002612","IRON TAB","325MG","180","Select","Select",""],["","00904759080","FEROSUL TAB","325MG","60","Select","Select",""],["","16714008210","HYDROXYZ HCL TAB","25MG","30","Select","Select",""],["","81131009371","SV IRON TAB","325MG","60","Select","Select",""],["","45802006535","TRIAMCINOLONE ACETONIDE","0.5 %","60","Select","Select",""],["","31722071390","PANTOPRAZOLE SODIUM","40 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":""}]}]}