{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SHEVITA WOODSON","gend":1,"add":"127 N 8TH ST","city":"SUFFOLK","state":"VA","zip":"23434-9998","dob":"1983-08-05","age":"","mstatus":"","insh":"20045837*01","cliId":"","pno":"757\/332-3340","cno":"757\/332-3340","email":"","ename":"","eno":"","pphy":"MARKOVIC, VLADIMIR MD","ppno":"757\/393-6363","pcpadd":"3415 GRANBY STREET","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23504,"pcpcounty":"","pcpid":102266,"pcpname":"Hampton Roads Community Health Center","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"757\/338-7254","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":["L97.311","L90.5","T25.011S","E11.65","R20.2","B35.1","J06.9","Z20.822"],"date":["2020-06-16","2020-06-16","2020-06-16","2020-06-16","2020-06-16","2020-02-06","2021-08-19","2021-08-19"],"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":[["","00088221905","LANTUS ","100\/ML","6","Select","Select",""],["","33342006410","VALSARTAN ","160MG","90","Select","Select",""],["","68645051654","AMLODIPINE ","10MG","90","Select","Select",""],["","00169406012","VICTOZA ","18MG\/3ML","9","Select","Select",""],["","08290320109","BD  PEN NEEDL","31GX8MM","200","Select","Select",""],["","67877022310","GABAPENTIN ","300MG","30","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","68180096301","ALBUTEROL ","HFA","8","Select","Select",""],["","33342006410","VALSARTAN","160MG","30","Select","Select",""],["","00088221905","LANTUS","100\/ML","15","Select","Select",""],["","00169406012","VICTOZA","18MG\/3ML","27","Select","Select",""],["","08290320109","BD PEN NEEDL","31GX8MM","200","Select","Select",""],["","68645051654","AMLODIPINE","10MG","30","Select","Select",""],["","68180096301","ALBUTEROL","HFA","8","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","67877022310","GABAPENTIN","300MG","30","Select","Select",""],["","67877051110","ATORVASTATIN ","TAB 10MG","14","Select","Select",""],["","60505082901","FLUTICASONE ","SPR 50MCG","16","Select","Select",""],["","68645058359","METFORMIN ","TAB 850MG","180","Select","Select",""],["","00067815204","VOLTAREN ","GEL 0.01","45","Select","Select",""],["","53885024510","ONETOUCH ","TES ULTRA","100","Select","Select",""],["","29300034905","ALLOPURINOL ","TAB 100MG","30","Select","Select",""],["","00597007541","SPIRIVA ","CAP HANDIHLR","30","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","",""],["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":""}]}]}