{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TIMOTHY   C BOWDEN","gend":0,"add":"3464 MANGROVE AVE APT 1","city":"NORFOLK","state":"VA","zip":"23502-9998","dob":"1964-06-16","age":"","mstatus":"","insh":"20024173*01","cliId":"","pno":"385\/319-3194","cno":"385\/319-3194","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":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/397-0047","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F31.31","F33.1","F41.8","J44.9","I65.23","I10.","R42.","E11.9","R79.89","R74.0","M54.5","M48.062","I70.90","G89.29","Z68.25","M16.0","M70.61","M51.36","I73.9","H55.00","F17.210","Z03.818","M19.90","E55.9","Z87.891","E78.2","Z68.24","J43.9","F33.41","R73.03","K21.9","Z76.89"],"date":["2021-01-05","2021-08-09","2021-08-09","2021-08-01","2021-07-26","2021-07-26","2020-09-02","2020-09-02","2020-01-17","2020-01-17","2021-07-08","2021-07-08","2021-07-08","2021-07-08","2021-07-08","2021-03-25","2021-03-25","2021-03-25","2021-08-31","2020-04-14","2020-04-14","2020-04-14","2020-09-02","2020-09-02","2021-07-26","2021-07-26","2021-07-26","2021-07-26","2021-07-26","2021-07-26","2021-07-26","2021-07-26"],"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":[["","62332000131","FAMOTIDINE ","20MG","60","Select","Select",""],["","00115180401","HYDROXYZ ","50MG","60","Select","Select",""],["","65862001305","SERTRALINE ","100MG","30","Select","Select",""],["","70710122801","AMITRIPTYLIN ","75MG","30","Select","Select",""],["","68180098003","LISINOPRIL ","10MG","30","Select","Select",""],["","55111012305","ATORVASTATIN ","40MG","30","Select","Select",""],["","69452015120","VITAMIN ","50000UNT","4","Select","Select",""],["","57963010101","MECLIZINE ","","90","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","00254100752","ALBUTEROL ","HFA","13","Select","Select",""],["","29300012510","MELOXICAM ","15MG","90","Select","Select",""],["","58602070584","ACID ","10MG","30","Select","Select",""],["","68180098003","LISINOPRIL","10MG","30","Select","Select",""],["","70710122700","AMITRIPTYLIN","50MG","30","Select","Select",""],["","00115180401","HYDROXYZ","50MG","60","Select","Select",""],["","62332000131","FAMOTIDINE","20MG","60","Select","Select",""],["","65862001305","SERTRALINE","100MG","30","Select","Select",""],["","55111012305","ATORVASTATIN","40MG","30","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","59746012106","MECLIZINE","25MG","30","Select","Select",""],["","00254100752","ALBUTEROL","HFA","13","Select","Select",""],["","69452015120","VITAMIN","50000UNT","4","Select","Select",""],["","58602070584","ACID","10MG","30","Select","Select",""],["","29300012510","MELOXICAM","15MG","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","",""],["Yes","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":""}]}]}