{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"EDWARD ARMSTRONG","gend":0,"add":"5630 HIGH ST W APT H","city":"PORTSMOUTH","state":"VA","zip":"23703-9998","dob":"1962-09-04","age":"","mstatus":"","insh":"20046538*01","cliId":"","pno":"410\/858-8743","cno":"410\/858-8743","email":"","ename":"","eno":"","pphy":"CRISOSTOMO, CHRISTEN MD","ppno":"757\/923-9660","pcpadd":"SUITE 3 2401 GODWIN BLVD","pcpcity":"SUFFOLK","pcpstate":"VA","pcpzip":23434,"pcpcounty":"","pcpid":133029,"pcpname":"Cedar Road Medical Associates","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/923-9665","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I69.354","R26.2","G40.909","F41.8","I10.","Z12.11"],"date":["2020-09-03","2020-01-06","2020-09-03","2020-09-03","2020-09-03","2020-09-03"],"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":[["","00085113204","PROVENTIL","HFA","7","Select","Select",""],["","65162021210","PHENYTOIN ","100MG","90","Select","Select",""],["","64380080707","IBUPROFEN ","800MG","60","Select","Select",""],["","29300012510","MELOXICAM ","15MG","30","Select","Select",""],["","68180011302","LEVETIRACETA ","500MG","60","Select","Select",""],["","68382009810","PAROXETINE ","20MG","30","Select","Select",""],["","00115166101","PROPRANOLOL ","40MG","90","Select","Select",""],["","70377000415","SIMVASTATIN ","40MG","30","Select","Select",""],["","00378699252","ALBUTEROL ","1.25MG\/3","75","Select","Select",""],["","00085113204","PROVENTIL ","HFA","7","Select","Select",""],["","00904675180","ASPIRIN ","81MG EC","30","Select","Select",""],["","10702000201","PROMETHAZINE ","12.5MG","20","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","00406048410","APAP\/CODEINE ","300-30MG","12","Select","Select",""],["","00173068220","VENTOLIN ","","18","Select","Select",""],["","59267100001","PFIZER ","COVID-19","0","Select","Select",""],["","70377000415","SIMVASTATIN","40MG","30","Select","Select",""],["","00115166101","PROPRANOLOL","40MG","90","Select","Select",""],["","68382009810","PAROXETINE","20MG","30","Select","Select",""],["","00904678370","ASPIRIN","81MG EC","30","Select","Select",""],["","29300012510","MELOXICAM","15MG","30","Select","Select",""],["","68180011302","LEVETIRACETA","500MG","60","Select","Select",""],["","64380080707","IBUPROFEN","800MG","60","Select","Select",""],["","65162021210","PHENYTOIN","100MG","90","Select","Select",""],["","00378699252","ALBUTEROL","1.25MG\/3","75","Select","Select",""],["","10702000201","PROMETHAZINE","12.5MG","20","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","00173068220","VENTOLIN","","18","Select","Select",""],["","59267100001","PFIZER","COVID-19","0","Select","Select",""],["","00406048410","APAP\/CODEINE","300-30MG","12","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":[[["No","Select","","","","","Select","",""],["No","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":""}]}]}