{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"RAY EVERETTE","gend":0,"add":"2701 MARTHA DR","city":"CHESAPEAKE","state":"VA","zip":"23323-9998","dob":"1966-12-09","age":"","mstatus":"","insh":"20055867*01","cliId":"","pno":"786\/372-5764","cno":"786\/372-5764","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":["Z20.822","R06.89","N28.89","R91.1","R07.9","R06.02","R05.","F17.200","E88.09","Z68.36","N50.811","N50.812","N45.1","E11.21","I10.","E78.5","J44.9","Z23.","E66.01","F19.10","Z76.0","R07.89","Z68.41"],"date":["2021-02-17","2021-02-17","2021-04-13","2021-04-13","2021-02-17","2021-02-17","2020-01-07","2020-01-07","2021-03-24","2021-03-24","2021-05-04","2021-05-04","2021-05-04","2020-10-28","2020-10-28","2020-10-28","2020-10-28","2020-10-28","2020-10-28","2020-10-28","2020-10-28","2020-10-28","2020-10-28"],"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":[["","08290324912","INSULIN ","1ML\/31G","60","Select","Select",""],["","68001033708","LISINOPRIL ","40MG","30","Select","Select",""],["","53885027210","ONETOUCH ","VERIO","100","Select","Select",""],["","24385002868","GNP ","81MG","90","Select","Select",""],["","66993058597","FLUTIC\/SALME ","250\/50","60","Select","Select",""],["","57237017190","ROSUVASTATIN ","40MG","30","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","45802008801","ALBUTEROL ","HFA","8","Select","Select",""],["","00173069600","ADVAIR ","250\/50","60","Select","Select",""],["","00002871501","HUMULIN ","70\/30","10","Select","Select",""],["","65862053750","LEVOFLOXACIN ","500MG","10","Select","Select",""],["","08290324912","INSULIN","1ML\/31G","60","Select","Select",""],["","68001033708","LISINOPRIL","40MG","30","Select","Select",""],["","53885027150","ONETOUCH","VERIO","50","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","45802008801","ALBUTEROL","HFA","8","Select","Select",""],["","66993058597","FLUTIC\/SALME","250\/50","60","Select","Select",""],["","57237017190","ROSUVASTATIN","40MG","30","Select","Select",""],["","24385002868","GNP","81MG","30","Select","Select",""],["","00002871501","HUMULIN","70\/30","10","Select","Select",""],["","65862053750","LEVOFLOXACIN","500MG","10","Select","Select",""],["","00173069600","ADVAIR","250\/50","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":[[["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":""}]}]}