{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MELISSA BALL","gend":1,"add":"702 REDGATE AVE APT 3","city":"NORFOLK","state":"VA","zip":"23507-9998","dob":"1974-04-10","age":"","mstatus":"","insh":"20023509*01","cliId":"","pno":"757\/623-8383","cno":"757\/623-8383","email":"","ename":"","eno":"","pphy":"TUCKER, MICHAEL MD","ppno":"757\/625-3777","pcpadd":"110 KINGSLEY LANE SUITE 411","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23505,"pcpcounty":"","pcpid":110850,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"757\/318-0546","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/625-7411","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G90.9","R55.","M19.90","G11.9","R79.89","H55.00","Z92.29","M25.561","M25.562","Z00.00","I10.","F31.9","S93.402A","M79.672","K59.00","K62.5","K51.90","G32.81","G47.33","F41.9","M47.816","G89.4","R13.10","R47.1","Z97.8","Z79.891","E55.9","G31.9","R40.0","G47.09","G47.37","G47.20","Z87.19","M17.0","M17.11","M17.12","S82.55XA","R25.2","G90.4","M17.10","Z45.1"],"date":["2021-04-05","2021-04-05","2021-08-27","2021-05-28","2021-04-23","2021-03-09","2021-03-24","2020-07-02","2020-07-02","2020-07-09","2021-02-19","2020-07-09","2020-09-10","2020-09-10","2021-02-17","2021-02-17","2021-02-17","2021-02-17","2021-03-09","2020-02-17","2021-07-01","2021-09-22","2021-05-28","2021-05-28","2021-07-01","2021-01-13","2021-08-27","2021-07-01","2021-02-09","2021-02-09","2021-02-09","2020-06-12","2021-02-08","2020-01-30","2020-01-30","2020-01-30","2020-09-04","2020-09-18","2021-07-20","2021-08-27","2021-09-22"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","",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":[["","00406012505","HYDROCO\/APAP ","10-325MG","120","Select","Select",""],["","00310197030","MOVANTIK ","25MG","30","Select","Select",""],["","69547035302","NARCAN ","","2","Select","Select",""],["","00527133701","BACLOFEN ","20MG","90","Select","Select",""],["","00378034505","DIAZEPAM ","5MG","60","Select","Select",""],["","00555099702","FLUDROCORT ","0.1MG","25","Select","Select",""],["","00245021311","MIDODRINE ","10MG","15","Select","Select",""],["","29300017216","MEMANTINE ","HCL 10MG","60","Select","Select",""],["","70710134403","RAMELTEON ","8MG","30","Select","Select",""],["","65862001305","SERTRALINE ","100MG","45","Select","Select",""],["","00006483702","PNEUMOVAX ","25\/0.5","0","Select","Select",""],["","00591352530","LIDOCAINE ","5%","90","Select","Select",""],["","00005197102","PREVNAR ","","0","Select","Select",""],["","60505057501","OLOPATADINE ","0.10%","5","Select","Select",""],["","67618010160","COLACE ","100MG","60","Select","Select",""],["","65862042005","SMZ\/TMP ","800-160","14","Select","Select",""],["","69452015120","VITAMIN ","50000UNT","4","Select","Select",""],["","65162010150","GABAPENTIN ","100MG","60","Select","Select",""],["","00406012505","HYDROCO\/APAP","10-325MG","120","Select","Select",""],["","00378034505","DIAZEPAM","5MG","60","Select","Select",""],["","00245021311","MIDODRINE","10MG","90","Select","Select",""],["","00527133701","BACLOFEN","20MG","90","Select","Select",""],["","65862001305","SERTRALINE","100MG","45","Select","Select",""],["","00310197030","MOVANTIK","25MG","30","Select","Select",""],["","69547035302","NARCAN","","2","Select","Select",""],["","70710134403","RAMELTEON","8MG","30","Select","Select",""],["","00006483702","PNEUMOVAX","25\/0.5","0","Select","Select",""],["","00555099702","FLUDROCORT","0.1MG","25","Select","Select",""],["","00005197102","PREVNAR","","0","Select","Select",""],["","00591352530","LIDOCAINE","5%","90","Select","Select",""],["","29300017216","MEMANTINE","HCL 10MG","60","Select","Select",""],["","60505057501","OLOPATADINE","0.10%","5","Select","Select",""],["","65862042005","SMZ\/TMP","800-160","14","Select","Select",""],["","67618010160","COLACE","100MG","60","Select","Select",""],["","69452015120","VITAMIN","50000UNT","4","Select","Select",""],["","65162010150","GABAPENTIN","100MG","60","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","",""],["No","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":""}]}]}