{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ANNETTE DIXON","gend":1,"add":"1933 REDGATE DR","city":"PORTSMOUTH","state":"VA","zip":"23702-9998","dob":"1960-09-22","age":"","mstatus":"","insh":"2013883*01","cliId":"","pno":"757\/718-7341","cno":"757\/718-7341","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":"757\/397-0047","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R06.02","Z94.0","T86.10","R22.1","R59.1","L04.0","Z11.59","N25.81","E55.9","R59.0","R93.89","D64.9","Z83.2","Z68.30","R79.89","I12.9","N18.30","R07.9","Z98.84","Z88.8","M81.0","I10.","Z78.9","R06.09","K21.9","I51.7","G45.9","R42.","R20.0","N18.32","R91.8","R68.89","R87.810","Z68.29","D63.8","N18.9","D63.1","E87.6","I11.0","I50.9","E66.01","E78.00","E78.5","Z98.51","E87.5","Z12.11","I67.4","Z68.28","H69.93","R25.2","R80.9","R06.00","Z98.890","Z87.19","N10.","R22.2","F41.1","T86.12","N17.9","N18.3","E86.0","I95.9","Z79.82","Z79.83","Z79.899","Z86.19","Z82.49","Z84.1","Z78.0","I13.0","E87.1","D84.9","D86.1","I16.0","M19.90","Z00.00","Z71.89","N18.6","Z01.810","R94.4","M79.671","M79.605","M79.661","M25.562","M79.662"],"date":["2021-06-08","2021-10-20","2021-06-08","2020-11-02","2021-03-12","2020-11-02","2021-06-23","2021-06-23","2021-06-23","2020-11-05","2020-10-22","2021-06-08","2021-01-20","2021-10-20","2020-10-19","2020-10-19","2021-10-20","2020-10-19","2021-06-08","2020-10-19","2021-03-12","2021-10-20","2021-03-11","2020-01-07","2021-10-20","2020-01-03","2020-11-24","2020-11-04","2020-11-04","2020-11-24","2020-11-24","2020-11-30","2020-11-24","2020-11-24","2021-01-20","2021-01-20","2021-01-20","2020-07-22","2020-03-05","2020-11-04","2020-03-05","2021-10-20","2020-11-04","2020-03-05","2021-07-02","2021-05-23","2020-11-04","2020-11-05","2021-02-28","2021-02-28","2021-06-08","2021-06-08","2021-06-08","2021-06-08","2021-06-08","2021-06-08","2020-01-02","2020-01-02","2020-01-07","2020-07-22","2020-01-02","2020-01-02","2020-01-02","2020-01-02","2020-01-02","2020-01-02","2020-01-02","2020-01-02","2020-07-22","2020-11-04","2020-11-04","2020-11-04","2020-11-04","2020-11-05","2020-11-04","2020-11-24","2020-11-24","2020-07-22","2020-10-28","2021-06-15","2021-06-15","2021-10-22","2021-10-22","2021-10-20","2021-10-22"],"priorHcc":["",null,"","","","","","","","","","","",null,"","",null,"","","","",null,"","",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":[["","16729004201","TACROLIMUS","1MG","-210","Select","Select",""],["","68382050010","OMEPRAZOLE","40MG","30","Select","Select",""],["","31722051901","HYDRALAZINE","10MG","90","Select","Select",""],["","65862014405","CARVEDILOL","12.5MG","60","Select","Select",""],["","65862032904","ALENDRONATE","70MG","4","Select","Select",""],["","00054016325","MYCOPHENOLAT","250MG","180","Select","Select",""],["","65162024709","CHLORTHALID","25MG","-30","Select","Select",""],["","00093317431","ALBUTEROL","HFA","8","Select","Select",""],["","00781107701","ALPRAZOLAM","0.5MG","30","Select","Select",""],["","00093314705","CEPHALEXIN","500MG","30","Select","Select",""],["","70539000102","TYMLOS","","2","Select","Select",""],["","00054429931","FUROSEMIDE","40MG","90","Select","Select",""],["","60505082901","FLUTICASONE","50MCG","-16","Select","Select",""],["","00173068220","VENTOLIN","","18","Select","Select",""],["","69452020720","CALCITRIOL","0.25MCG","36","Select","Select",""],["","55111012405","ATORVASTATIN","80MG","-20","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","00406012305","HYDROCO\/APAP","5-325MG","30","Select","Select",""],["","31722051901","HYDRALAZINE ","10MG","-90","Select","Select",""],["","16729004201","TACROLIMUS ","1MG","-210","Select","Select",""],["","65862014405","CARVEDILOL ","12.5MG","60","Select","Select",""],["","68382050010","OMEPRAZOLE ","40MG","30","Select","Select",""],["","00054016325","MYCOPHENOLAT ","250MG","180","Select","Select",""],["","65862032904","ALENDRONATE ","70MG","4","Select","Select",""],["","00781107701","ALPRAZOLAM ","0.5MG","30","Select","Select",""],["","65162024709","CHLORTHALID ","25MG","-30","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","00093317431","ALBUTEROL ","HFA","8","Select","Select",""],["","00406012305","HYDROCO\/APAP ","5-325MG","30","Select","Select",""],["","00173068220","VENTOLIN ","","18","Select","Select",""],["","70539000102","TYMLOS ","","2","Select","Select",""],["","55111012405","ATORVASTATIN ","80MG","-20","Select","Select",""],["","00093314705","CEPHALEXIN ","500MG","-30","Select","Select",""],["","00054429931","FUROSEMIDE ","40MG","90","Select","Select",""],["","60505082901","FLUTICASONE ","50MCG","-16","Select","Select",""],["","69452020720","CALCITRIOL ","0.25MCG","-36","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","",""],["Yes","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":""}]}]}