{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"APRIL   ALBRIGHT NOLAN","gend":1,"add":"2665 POWELL CIR","city":"CHESAPEAKE","state":"VA","zip":"23323-9998","dob":"1983-07-06","age":"","mstatus":"","insh":"1050837*01","cliId":"","pno":"757\/617-8301","cno":"757\/617-8301","email":"","ename":"","eno":"","pphy":"WELLS, JANELLE M MD","ppno":"757\/393-6363","pcpadd":"664 LINCOLN ST","pcpcity":"PORTSMOUTH","pcpstate":"VA","pcpzip":23704,"pcpcounty":"","pcpid":102266,"pcpname":"Hampton Roads Community Health Center","plan":"OHP","program":"ACA","lob":"Individual","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J01.90","J30.9","S73.191D","M75.02","E10.65","R68.81","K59.00","Z71.3","Z23.","S05.02XS","E78.01","Z96.41","E06.3","Z00.00","E03.9","R10.9","E55.9","R10.13","R11.2","E10.9","E78.00","Z87.891","Z91.040","Z91.018","Z79.890","Z79.899","Z20.828","S05.02XD","M25.551","K30.","R14.0","Z79.4","S05.02XA","Z01.818","R68.83","H10.12","H16.222","H52.13","F41.9","R42.","G47.00"],"date":["2021-03-02","2021-09-30","2020-06-15","2020-07-24","2021-11-04","2020-11-04","2020-10-07","2020-10-07","2021-04-22","2021-05-06","2020-04-20","2020-10-05","2021-11-04","2020-04-20","2021-06-21","2020-09-29","2020-09-29","2020-11-04","2020-11-04","2021-07-22","2020-11-03","2020-11-03","2020-11-03","2020-11-03","2020-11-03","2020-11-03","2021-09-17","2021-04-27","2020-04-03","2020-09-02","2020-09-02","2020-07-24","2021-04-26","2020-10-30","2021-03-02","2021-07-12","2021-07-22","2021-07-22","2021-10-26","2021-11-04","2021-10-26"],"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":[["","00406051205","OXYCOD\/APAP","5-325MG","-21","Select","Select",""],["","49884061153","TIZANIDINE","2MG","-30","Select","Select",""],["","00002751001","HUMALOG","100\/ML","40","Select","Select",""],["","69452015120","VITAMIN","50000UNT","4","Select","Select",""],["","69097084905","ESCITALOPRAM","20MG","30","Select","Select",""],["","68462032560","INDOMETHACIN","75MG ER","12","Select","Select",""],["","55111012105","ATORVASTATIN","10MG","-30","Select","Select",""],["","00074706890","SYNTHROID","125MCG","30","Select","Select",""],["","57599000101","FREESTYLE KIT SENSOR","SENSOR","2","Select","Select",""],["","60505082901","FLUTICASONE","50MCG","-48","Select","Select",""],["","66733077301","INSULIN","100\/ML","40","Select","Select",""],["","00781808926","AZITHROMYCIN","250MG","6","Select","Select",""],["","65862042005","SMZ\/TMP","800-160","40","Select","Select",""],["","51862094205","DIAZEPAM","5MG","-30","Select","Select",""],["","08508200005","OMNIPOD","5 PACK","20","Select","Select",""],["","17478071310","OFLOXACIN","0.3% OP","5","Select","Select",""],["","08627001601","DEXCOM","TRANSMIT","1","Select","Select",""],["","42794001812","LIOTHYRONINE","5MCG","60","Select","Select",""],["","64380080707","IBUPROFEN","800MG","20","Select","Select",""],["","00193731150","CONTOUR","NEXT","150","Select","Select",""],["","61314012605","KETOROLAC","0.50%","5","Select","Select",""],["","68180018001","CEFADROXIL","500MG","20","Select","Select",""],["","24208091055","ERYTHROMYCIN","5MG\/GM","4","Select","Select",""],["","66685100100","AMOX\/K","875-125","20","Select","Select",""],["","53885024450","ONETOUCH","ULTRA","-150","Select","Select",""],["","65702071110","ACCU-CHEK","GUIDE","150","Select","Select",""],["","00363905000","SOD","5% OP","4","Select","Select",""],["","49884061153","TIZANIDINE ","2MG","-30","Select","Select",""],["","53746020305","OXYCOD\/APAP ","5-325MG","21","Select","Select",""],["","69097084905","ESCITALOPRAM ","20MG","30","Select","Select",""],["","00002751001","HUMALOG ","100\/ML","40","Select","Select",""],["","00074706890","SYNTHROID ","125MCG","30","Select","Select",""],["","57599000101","FREESTYLE    KIT SENSOR","SENSOR","2","Select","Select",""],["","69452015120","VITAMIN ","50000UNT","4","Select","Select",""],["","55111012105","ATORVASTATIN ","10MG","30","Select","Select",""],["","68462032560","INDOMETHACIN ","75MG ER","12","Select","Select",""],["","65862042005","SMZ\/TMP ","800-160","40","Select","Select",""],["","60505082901","FLUTICASONE ","50MCG","-48","Select","Select",""],["","51862094205","DIAZEPAM ","5MG","2","Select","Select",""],["","00781808926","AZITHROMYCIN ","250MG","6","Select","Select",""],["","42794001812","LIOTHYRONINE ","5MCG","60","Select","Select",""],["","66733077301","INSULIN ","100\/ML","40","Select","Select",""],["","64380080707","IBUPROFEN ","800MG","20","Select","Select",""],["","08508200005","OMNIPOD ","5 PACK","15","Select","Select",""],["","66685100100","AMOX\/K ","875-125","20","Select","Select",""],["","68180018001","CEFADROXIL ","500MG","20","Select","Select",""],["","00193731150","CONTOUR ","NEXT","150","Select","Select",""],["","65702071110","ACCU-CHEK ","GUIDE","150","Select","Select",""],["","64980051505","OFLOXACIN ","0.3% OP","5","Select","Select",""],["","24208091055","ERYTHROMYCIN ","5MG\/GM","4","Select","Select",""],["","53885024450","ONETOUCH ","ULTRA","150","Select","Select",""],["","00363905000","SOD ","5% OP","4","Select","Select",""],["","61314012605","KETOROLAC ","0.50%","5","Select","Select",""],["","08627001601","DEXCOM ","TRANSMIT","1","Select","Select",""],["","61314030802","AZELASTINE ","0.05%","6","Select","Select",""],["","61314030802","AZELASTINE","0.05%","6","Select","Select",""],["","65862001205","SERTRALINE","50MG","90","Select","Select",""],["","60505265301","TRAZODONE","50MG","90","Select","Select",""],["","68382080510","TRAZODONE ","TAB 50MG","90","Select","Select",""],["","65862001305","SERTRALINE ","TAB 100MG","90","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","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","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":""}]}]}