{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"PRENTIS TOWNSEND","gend":0,"add":"31 BUCHANAN AVE PORTSMOUTH VIRGINIA PORTSMOUTH CITY","city":"PORTSMOUTH","state":"VA","zip":"23704-9998","dob":"1977-11-12","age":"","mstatus":"","insh":"900041237*01","cliId":"","pno":"757\/535-8339","cno":"","email":"","ename":"","eno":"","pphy":"ROSENBERG, DAVID MD","ppno":"757\/393-6363","pcpadd":"664 LINCOLN STREET","pcpcity":"PORTSMOUTH","pcpstate":"VA","pcpzip":23704,"pcpcounty":"","pcpid":"","pcpname":"Hampton Roads Community Health Center","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"TIDEWATER","aligned":"Y","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/397-0047","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["A41.9","D50.9","E11.9","F17.210","E87.2","Z53.20","U07.1","N17.9","N40.0","J69.0","J12.82","E87.6","I10.","E66.9","D57.3","E78.5","G93.41","R78.81","K57.92","Z20.822","D72.829","K57.20","Z68.37","R39.81","I63.9","I69.354","B35.1","L20.89","I63.00","L85.1","A41.50","R79.1","R50.9","K57.32","F43.21","J18.9","J45.40","Z09.","I69.359","M62.81","E11.65","E66.01","F31.4","Z68.39","M62.422","Z13.1","Z72.0","N39.44","N52.9","Z91.19"],"date":["2021-01-29","2021-01-18","2021-01-18","2021-01-18","2021-01-18","2021-01-18","2021-01-22","2021-01-18","2021-01-18","2021-01-25","2021-01-18","2021-01-18","2021-08-12","2021-01-21","2021-01-18","2021-01-18","2021-01-29","2021-01-25","2021-01-25","2021-01-25","2021-01-25","2021-01-25","2021-02-11","2021-05-31","2021-08-12","2021-05-31","2021-06-28","2021-06-28","2021-06-28","2021-06-28","2021-01-22","2021-01-23","2021-01-23","2021-04-23","2021-02-23","2021-01-29","2021-02-01","2021-02-11","2021-09-14","2021-09-14","2021-01-21","2021-01-21","2021-01-18","2021-01-18","2021-08-12","2021-05-13","2021-08-12","2021-05-13","2021-08-12","2021-08-12"],"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":[]}]},{"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":[["","00597002402","COMBIVENT RESPIMAT                                                    ","20-100","4","Select","Select",""],["","00093505998","ATORVASTATIN CALCIUM                                                  ","20MG","30","Select","Select",""],["","26608000150","BIO K CAPS                                                            ","","10","Select","Select",""],["","55111028050","LEVOFLOXACIN                                                          ","500MG","7","Select","Select",""],["","50111033401","METRONIDAZOLE                                                         ","500MG","14","Select","Select",""],["","00832105415","BACLOFEN                                                              ","10MG","90","Select","Select",""],["","31722070290","LOSARTAN POTASSIUM                                                    ","100MG","90","Select","Select",""],["","31722071101","SILDENAFIL                                                            ","100MG","5","Select","Select",""],["","00574206130","CICLOPIROX                                                            ","0.77%","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":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"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":""}]}]}