{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ALEXIS   M DELBRIDGE","gend":1,"add":"1529   CENTER AVENUE                                        ","city":"PORTSMOUTH                    ","state":"VA","zip":"23704-6801","dob":"1987-04-30","age":"","mstatus":"","insh":10228487,"cliId":"","pno":7578391379,"cno":7578391379,"email":"","ename":"","eno":"","pphy":"ROSENBERG, DAVID                                            ","ppno":"","pcpadd":"664 LINCOLN STREET,Hofheimer Hall 1st Floor Suite 118","pcpcity":"PORTSMOUTH                    ","pcpstate":"VA","pcpzip":237044818,"pcpcounty":"","pcpid":"P0124722","pcpname":"PORTSMOUTH COMMUNITY HEALTH CENTER INC","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"TIDEWATER","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"1529   CENTER AVENUE                                        ","madd2":"                                                            ","madd3":"","mcity":"PORTSMOUTH                    ","mstate":"VA","mzip":"23704-6801","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z34.02","Z34.80","O99.212","Z3A.24","O35.9XX0","Z3A.25","Z34.03","O99.210","Z23","Z3A.32","O99.213","Z3A.34","O14.94","O41.1230","Z37.0","O99.113","D58.2","O76","O70.0","Z3A.38","Z28.21","O80","Z3A.39","Z30.9","Z30.09","Z30.42","E66.9"],"date":["2020-03-23","2020-02-18","2020-04-01","2020-03-23","2020-04-01","2020-04-01","2020-06-04","2020-05-20","2020-05-20","2020-05-20","2020-06-04","2020-06-04","2020-07-03","2020-07-03","2020-07-04","2020-07-03","2020-07-03","2020-07-03","2020-07-03","2020-07-03","2020-07-03","2020-07-04","2020-07-04","2021-03-02","2020-10-13","2021-03-05","2021-03-02"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","",""]}},{"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":[["","00548570100","MEDROXYPR","150MG\/ML","1","Select","Select",""],["","00904759080","FEROSUL","325MG","30","Select","Select",""],["","00904585652","CALCIUM","600MG","60","Select","Select",""],["","00904645780","DOK","100MG","30","Select","Select",""],["","65162046650","IBUPROFEN","800MG","30","Select","Select",""],["","39328010610","PRENATAL","27-1MG","30","Select","Select",""],["","66685100101","AMOX\/K","875-125","10","Select","Select",""],["","00548570100","MEDROXYPR ","INJ 150MG\/ML","1","Select","Select",""],["","00904759080","FEROSUL ","TAB 325MG","30","Select","Select",""],["","00904585652","CALCIUM ","TAB 600MG","60","Select","Select",""],["","00904645780","DOK ","CAP 100MG","30","Select","Select",""],["","65162046650","IBUPROFEN ","TAB 800MG","30","Select","Select",""],["","39328010610","PRENATAL ","TAB 27-1MG","30","Select","Select",""],["","66685100101","AMOX\/K ","TAB 875-125","10","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":[[["No","Select","","","","","Select","",""],["No","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":""}]}]}