{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SHAMEEK BAKER","gend":0,"add":"343 50TH STREET                                             ","city":"NEWPORT NEWS                  ","state":"VA","zip":"23607-2519","dob":"1979-02-22","age":"","mstatus":"","insh":10179082,"cliId":"","pno":7573102338,"cno":"","email":"","ename":"","eno":"","pphy":"BOWERS, LEO C                                               ","ppno":7578272127,"pcpadd":"26 WINE STREET,Ste H","pcpcity":"HAMPTON                       ","pcpstate":"VA","pcpzip":236693584,"pcpcounty":"","pcpid":"P0060337","pcpname":"PENINSULA INSTITUTE FOR COMMUNITY HEALTH INC","ano":"","add2":"UNIT C                                                      ","add3":"","madd1":"705 River Rock Way Ste 101                                  ","madd2":"                                                            ","madd3":"","mcity":"Newport News                  ","mstate":"VA","mzip":"23608-0054","pcpfaxno":"","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"TIDEWATER","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M54.5","M54.41","M79.604","Z79.899","Z79.84","I10","E11.29","Z28.21","J10.1","J01.00","J18.9","R07.9","R20.0","M79.602","Z53.21","Z12.5","E78.5","Z20.828","U07.1","N20.0","R35.0","E11.9","B34.9","R42","M94.0","R59.0","E66.01","Z68.36"],"date":["2021-04-22","2019-10-08","2019-10-06","2019-10-06","2019-10-06","2021-11-19","2020-09-10","2020-09-10","2019-12-19","2019-12-19","2020-12-06","2020-02-14","2020-02-14","2020-02-14","2020-02-14","2020-06-10","2021-11-19","2021-09-30","2020-12-06","2021-01-13","2021-11-01","2021-11-19","2021-03-30","2021-06-27","2021-09-14","2021-09-14","2021-11-19","2021-11-19"],"priorHcc":["","","","","",null,"","","","","","","","","","",null,"","","",null,null,"","","","",null,null]}},{"a":[]}]},{"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":[]}]},{"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":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","55111012305","ATORVASTATIN","40MG","30","Select","Select",""],["","00363058714","ASPIRIN","81MG EC","30","Select","Select",""],["","65862042005","SMZ\/TMP","800-160","20","Select","Select",""],["","67877032105","IBUPROFEN","800MG","30","Select","Select",""],["","68645058459","METFORMIN","1000MG","60","Select","Select",""],["","33342006410","VALSARTAN","160MG","30","Select","Select",""],["","52817033200","CYCLOBENZAPR","10MG","15","Select","Select",""],["","00143993905","AMOXICILLIN","500MG","30","Select","Select",""],["","69238110005","DOXYCYCL","100MG","20","Select","Select",""],["","57237001401","TAMSULOSIN","0.4MG","15","Select","Select",""],["","65862039010","ONDANSETRON","4MG ODT","20","Select","Select",""],["","00093031401","KETOROLAC","10MG","15","Select","Select",""],["","55111012305","ATORVASTATIN ","TAB 40MG","30","Select","Select",""],["","00363058714","ASPIRIN ","TAB 81MG EC","30","Select","Select",""],["","65862042005","SMZ\/TMP ","TAB 800-160","20","Select","Select",""],["","67877032105","IBUPROFEN ","TAB 800MG","30","Select","Select",""],["","68645058459","METFORMIN ","TAB 1000MG","60","Select","Select",""],["","33342006410","VALSARTAN ","TAB 160MG","30","Select","Select",""],["","52817033200","CYCLOBENZAPR ","TAB 10MG","15","Select","Select",""],["","00143993905","AMOXICILLIN ","CAP 500MG","30","Select","Select",""],["","69238110005","DOXYCYCL ","CAP 100MG","20","Select","Select",""],["","57237001401","TAMSULOSIN ","CAP 0.4MG","15","Select","Select",""],["","65862039010","ONDANSETRON ","TAB 4MG ODT","20","Select","Select",""],["","00093031401","KETOROLAC ","TAB 10MG","15","Select","Select",""]]}},{"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":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[[["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""]]]},{"t":"Mini-Cog","q":[{"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":""}]}]}