{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DOMONIKI HARRIS","gend":1,"add":"156 BLUEJAY ST","city":"PRINCE GEORGE","state":"VA","zip":"23875-9998","dob":"1981-07-24","age":"","mstatus":"","insh":"2198009*01","cliId":"","pno":8048558474,"cno":8048558474,"email":"","ename":"","eno":"","pphy":"CHEEMA, RAZA M MD","ppno":8047962373,"pcpadd":"12901 BRIGGS RD,","pcpcity":"CHESTER","pcpstate":"VA","pcpzip":"23831-9998","pcpcounty":"","pcpid":"","pcpname":"Bon Secours - Southside Internal Medicine","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":8047489160,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["L91.8","L81.2","L83.","G47.33","M79.631","I10.","C78.00","K21.9","Z79.82","Z79.899","Z87.891","J06.9","Z20.822","N93.9","D25.0","D25.1","R07.9","I48.0","I11.9","E66.9","R42.","N84.0","Z01.818","Z23.","Z68.41","E78.2","D50.9","E66.01","D25.9","N92.0","Z48.816","R06.02","R60.9","N92.1","Z97.5","Z32.02","Z68.39","Z74.3","I36.1","NO DATA","I51.7","I48.91","I48.92","R77.8","Z82.49","E78.00","D50.8","Z12.31","E78.5","E87.6","Z01.810","R94.31","Z79.01"],"date":["2022-01-11","2022-01-11","2022-01-11","2023-07-13","2022-08-10","2023-08-09","2022-08-10","2022-10-27","2022-08-10","2022-08-10","2023-08-09","2022-11-14","2022-11-14","2022-12-09","2022-09-27","2022-09-27","2022-11-18","2023-08-09","2023-08-09","2022-10-31","2023-08-09","2022-12-09","2023-03-29","2022-10-27","2023-07-07","2022-10-27","2022-10-27","2023-07-13","2022-12-09","2022-12-09","2022-12-22","2023-07-07","2022-11-18","2023-01-12","2023-05-25","2022-09-27","2023-03-29","2023-04-01","2023-05-25","2023-05-25","2023-07-07","2023-07-13","2023-08-09","2023-05-26","2023-08-09","2023-07-13","2023-07-13","2023-07-13","2023-05-26","2023-05-25","2023-08-07","2023-08-09","2023-08-09"],"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":[["","45963067611","METOPROL SUC","TAB 50MG ER","90","Select","Select",""],["","00904759080","FEROSUL","325(65) MG","30","Select","Select",""],["","11917009215","FERROUS SULF","TAB 325MG","90","Select","Select",""],["","68382050010","OMEPRAZOLE","40 MG","30","Select","Select",""],["","00378632277","VALSART\/HCTZ","TAB 160-12.5","30","Select","Select",""],["","00406012305","HYDROCO\/APAP","TAB 5-325MG","12","Select","Select",""],["","70954006020","PREDNISONE","TAB 20MG","18","Select","Select",""],["","27241021601","CHLORTHALID","TAB 25MG","30","Select","Select",""],["","68462019005","NAPROXEN","TAB 500MG","10","Select","Select",""],["","45963067611","METOPROLOL SUCCINATE","50 MG","30","Select","Select",""],["","27241021601","CHLORTHALIDONE","25 MG","30","Select","Select",""],["","57664047758","METOPROLOL TARTRATE","50 MG","60","Select","Select",""],["","29300039810","AMLODIPINE BESYLATE","10 MG","90","Select","Select",""],["","62559038001","FLECAINIDE ACETATE","50 MG","60","Select","Select",""],["","45963067611","METOPROL SUC TAB","50MG ER","30","Select","Select",""],["","00378632577","VALSART\/HCTZ TAB","320-25MG","30","Select","Select",""],["","68382050010","OMEPRAZOLE CAP","40MG","30","Select","Select",""],["","11917009215","FERROUS SULF TAB","325MG","90","Select","Select",""],["","00904759080","FEROSUL TAB","325MG","30","Select","Select",""],["","70954006020","PREDNISONE TAB","20MG","18","Select","Select",""],["","27241021601","CHLORTHALID TAB","25MG","30","Select","Select",""],["","00406012305","HYDROCO\/APAP TAB","5-325MG","12","Select","Select",""],["","68462019005","NAPROXEN TAB","500MG","10","Select","Select",""],["","50458057930","XARELTO","20 MG","90","Select","Select",""],["","11917009215","FERROUS SULFATE","325(65) MG","90","Select","Select",""],["","00169418113","OZEMPIC .","25 OR 0.5","3","Select","Select",""],["","31722089901","COLCHICINE","0.6 MG","6","Select","Select",""],["","65862056090","PANTOPRAZOLE SODIUM","40 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":""}]}]}