{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ALGIE  L HARRISON","gend":0,"add":"2415 LAFAYETTE BLVD","city":"NORFOLK","state":"VA","zip":"23509-9998","dob":"1971-12-21","age":"","mstatus":"","insh":"2297251*01","cliId":"","pno":7574181670,"cno":7574181670,"email":"","ename":"","eno":"","pphy":"TAYLOR, ALEX MD","ppno":7576230095,"pcpadd":"SUITE 1 1401 TIDEWATER AVE,","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":"23504-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7576231203,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F10.20","I10.","B20.","F12.10","F14.20","F17.200","F12.20","R07.89","R05.9","Z20.822","NO DATA","M79.605","S97.111A","S90.111A","R05.8","Z21.","F17.210","M25.562","G89.29","E78.5","F25.0","F39.","F33.1"],"date":["2021-06-17","2022-06-22","2022-06-22","2022-09-28","2022-12-27","2022-12-27","2022-12-27","2021-11-28","2021-11-28","2021-11-28","2022-04-28","2022-04-28","2022-06-12","2022-06-12","2021-11-28","2021-11-28","2022-10-23","2022-10-23","2022-10-23","2021-03-11","2023-07-15","2023-07-10","2023-07-10"],"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":[["","55111012290","ATORVASTATIN","TAB 20MG","30","Select","Select",""],["","16729018301","HYDROCHLOROT","TAB 25MG","30","Select","Select",""],["","11822365670","ACETAMIN","TAB 500MG","40","Select","Select",""],["","65162046510","IBUPROFEN","TAB 600MG","20","Select","Select",""],["","61958250101","BIKTARVY","50-200-25","30","Select","Select",""],["","59746017506","PREDNISONE","TAB 20MG","18","Select","Select",""],["","46122045021","GNP LIDOCAIN","PAD 0.04","10","Select","Select",""],["","29300041301","CYCLOBENZAPR","TAB 5MG","15","Select","Select",""],["","42037010375","ECOTRIN LOW","TAB 81MG EC","30","Select","Select",""],["","52817031910","BACLOFEN","TAB 5MG","90","Select","Select",""],["","65162079108","LIDOCAINE","PAD 0.05","30","Select","Select",""],["","16729018317","HYDROCHLOROTHIAZIDE","25 MG","30","Select","Select",""],["","42037010375","ECOTRIN","81 MG","30","Select","Select",""],["","55111012290","ATORVASTATIN CALCIUM","20 MG","30","Select","Select",""],["","16729018301","HYDROCHLOROT TAB","25MG","30","Select","Select",""],["","61958250101","BIKTARVY TAB","","30","Select","Select",""],["","55111012290","ATORVASTATIN TAB","20MG","30","Select","Select",""],["","65162046510","IBUPROFEN TAB","600MG","20","Select","Select",""],["","42037010375","ECOTRIN LOW TAB","81MG EC","30","Select","Select",""],["","11822365670","ACETAMIN TAB","500MG","40","Select","Select",""],["","59746017506","PREDNISONE TAB","20MG","18","Select","Select",""],["","46122045021","GNP LIDOCAIN PAD","4%","10","Select","Select",""],["","29300041301","CYCLOBENZAPR TAB","5MG","15","Select","Select",""],["","52817031910","BACLOFEN TAB","5MG","90","Select","Select",""],["","65162079108","LIDOCAINE PAD","5%","30","Select","Select",""],["","42806041430","BUPROPION XL","150 MG","30","Select","Select",""],["","29300014801","QUETIAPINE FUMARATE","50 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":""}]}]}