{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SHAN GILMORE","gend":1,"add":"103 INDIANA LN","city":"PETERSBURG","state":"VA","zip":"23803-9998","dob":"1974-03-30","age":"","mstatus":"","insh":"2352773*01","cliId":"","pno":8048612062,"cno":8048612062,"email":"","ename":"","eno":"","pphy":"MUTHYALA, UMA DEVI MD","ppno":8045265566,"pcpadd":"12340 BERMUDA CROSSROADS LN,","pcpcity":"CHESTER","pcpstate":"VA","pcpzip":"23831-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":8045265568,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F33.2","F14.10","K31.89","R63.4","E11.65","E78.2","I10.","Z79.4","F43.23","F33.3","F43.12","E87.6","E83.42","E11.9","E78.5","F17.210","Z63.4","Z79.899","R41.82","Z12.31","Z71.89","Z71.3","E11.42","NO DATA","F41.9","R40.20","R40.2431","T40.1X2A","F11.129","R00.0","R61.","R06.2","J20.9","R10.9","R11.2","R60.0","E03.9","Z02.83","F31.30","F43.10"],"date":["2021-02-25","2022-03-14","2021-06-24","2021-06-24","2021-06-29","2021-06-29","2021-06-29","2022-01-28","2022-02-01","2021-01-10","2021-01-08","2022-01-28","2022-01-28","2023-05-31","2022-01-28","2022-01-28","2022-01-28","2022-01-28","2022-01-28","2022-07-07","2022-07-07","2022-07-07","2022-07-07","2022-07-07","2022-07-07","2022-01-28","2022-01-28","2022-01-28","2022-01-28","2022-01-28","2022-01-28","2021-01-15","2021-01-15","2023-05-31","2023-05-31","2023-05-31","2023-05-31","2023-05-31","2023-06-04","2023-06-04"],"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":[["","53885000810","ONETOUCH DEL","MIS PLUS 33G","100","Select","Select",""],["","00173068220","VENTOLIN HFA","AER ","18","Select","Select",""],["","00002880559","HUMULIN N","INJ U-100KWP","15","Select","Select",""],["","00904673080","ACETAMIN","TAB 500MG","60","Select","Select",""],["","00169633910","NOVOLOG","INJ FLEXPEN","15","Select","Select",""],["","67877022405","GABAPENTIN","CAP 400MG","90","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","8","Select","Select",""],["","13668021730","ARIPIPRAZOLE","TAB 5MG","30","Select","Select",""],["","08290320109","BD PEN NEEDL","MIS 31GX8MM","150","Select","Select",""],["","52817018000","CLONIDINE","TAB 0.1MG","60","Select","Select",""],["","53885004401","ONE TOUCH","KIT VERIO FL","1","Select","Select",""],["","53885027150","ONETOUCH","TES VERIO","100","Select","Select",""],["","65862001205","SERTRALINE","TAB 50MG","30","Select","Select",""],["","42806016101","HYDROXYZ HCL","TAB 50MG","60","Select","Select",""],["","60505257808","ATORVASTATIN","TAB 10MG","30","Select","Select",""],["","50111056003","TRAZODONE","TAB 50MG","30","Select","Select",""],["","86227090055","SURE COMFORT","29 G X1\/2\"","100","Select","Select",""],["","08470355001","UNIFINE PENTIPS","31 GX3\/16\"","100","Select","Select",""],["","00169300315","NOVOLIN R FLEXPEN","100\/ML (3)","15","Select","Select",""],["","00002882427","HUMULIN R U-","500 KWIKPEN 500\/ML (3)","6","Select","Select",""],["","00002821501","HUMULIN R","100\/ML","10","Select","Select",""],["","00088221905","LANTUS SOLOSTAR","100\/ML (3)","15","Select","Select",""],["","00904673080","ACETAMIN TAB","500MG","60","Select","Select",""],["","00173068220","VENTOLIN HFA AER","","18","Select","Select",""],["","00002880559","HUMULIN N INJ U-","100KWP","15","Select","Select",""],["","00093317431","ALBUTEROL AER HFA","","8","Select","Select",""],["","76204020025","ALBUTEROL NEB","0.083%","75","Select","Select",""],["","00169633910","NOVOLOG INJ FLEXPEN","","15","Select","Select",""],["","53885000810","ONETOUCH DEL MIS PLUS","33G","100","Select","Select",""],["","53885004401","ONE TOUCH KIT VERIO FL","","1","Select","Select",""],["","53885027150","ONETOUCH TES VERIO","","100","Select","Select",""],["","08290320109","BD PEN NEEDL MIS","31GX8MM","150","Select","Select",""],["","52817018000","CLONIDINE TAB","0.1MG","60","Select","Select",""],["","13668021730","ARIPIPRAZOLE TAB","5MG","30","Select","Select",""],["","67877022405","GABAPENTIN CAP","400MG","90","Select","Select",""],["","65862001205","SERTRALINE TAB","50MG","30","Select","Select",""],["","50111056003","TRAZODONE TAB","50MG","30","Select","Select",""],["","42806016101","HYDROXYZ HCL TAB","50MG","60","Select","Select",""],["","60505257808","ATORVASTATIN TAB","10MG","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":""}]}]}