{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LILONGO  M LEWIS","gend":1,"add":"1258 S PORTSMOUTH BLVD","city":"SUFFOLK","state":"VA","zip":"23434-9998","dob":"1982-04-11","age":"","mstatus":"","insh":"6450962*01","cliId":"","pno":7576742718,"cno":7576742718,"email":"","ename":"","eno":"","pphy":"JONES, SHAVON C MD","ppno":7579251866,"pcpadd":"157 N MAIN ST,","pcpcity":"SUFFOLK","pcpstate":"VA","pcpzip":"23434-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7579280902,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["S93.491A","F31.2","I51.7","R07.89","R77.8","F14.90","R03.0","F14.259","L08.9","J06.9","Z76.0","F31.9","Z79.899","Z85.41","F17.210","Z88.5","R09.89","R07.9","I16.0","F14.10","R52.","R60.9","M25.571","W19.XXXA","M25.532","M79.642","F41.1","F41.9","Z11.52","Z20.822","Z02.79","F31.13","S62.102A","S93.401A","R10.13","R11.10","R06.89","R45.7","F23.","F19.10","I10.","Z86.59"],"date":["2021-06-15","2021-11-30","2022-03-24","2022-03-24","2022-03-24","2022-03-24","2022-03-24","2022-09-01","2022-07-16","2022-07-16","2022-07-16","2022-07-16","2022-07-16","2022-07-27","2022-07-27","2022-07-16","2022-07-16","2022-03-24","2022-03-24","2022-03-24","2021-06-08","2021-06-08","2021-06-08","2021-06-08","2021-06-16","2021-06-16","2022-03-23","2022-03-24","2022-07-27","2022-07-27","2022-07-27","2022-12-22","2021-06-08","2021-06-08","2021-08-21","2021-08-21","2022-03-24","2021-09-11","2021-09-11","2021-09-11","2021-09-11","2022-07-16"],"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":[["","00173068220","VENTOLIN HFA AER","","18","Select","Select",""],["","66993001968","ALBUTEROL AER HFA","","18","Select","Select",""],["","00832154011","HALOPERIDOL TAB","5MG","60","Select","Select",""],["","64380071206","BENZONATATE CAP","100MG","30","Select","Select",""],["","59267102503","PFIZER VACC INJ ADLT RTU","","0","Select","Select",""],["","00228202910","ALPRAZOLAM TAB","0.5MG","30","Select","Select",""],["","60432026415","FLUTICASONE SPR","50MCG","16","Select","Select",""],["","65162046510","IBUPROFEN TAB","600MG","20","Select","Select",""],["","69238110005","DOXYCYCL HYC CAP","100MG","20","Select","Select",""],["","69315013601","BENZTROPINE TAB","0.5MG","60","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":""}]}]}