{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ROBIN  M LACY","gend":1,"add":"1411 GORT CT APT B","city":"PORTSMOUTH","state":"VA","zip":"23701-9998","dob":"1983-04-14","age":"","mstatus":"","insh":"2286929*01","cliId":"","pno":"347\/762-4669","cno":"347\/762-4669","email":"","ename":"","eno":"","pphy":"ANGLIN, VICTOR TEODORO MD","ppno":"757\/738-1225","pcpadd":"3537 AIRLINE BLVD STE 1","pcpcity":"PORTSMOUTH","pcpstate":"VA","pcpzip":23701,"pcpcounty":"","pcpid":207840,"pcpname":"AIRLINE BOULEVARD MEDICAL ASSOCIATES","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/448-1037","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I26.99","S39.012A","G57.03","M99.08","M99.01","M99.03","M99.04","M99.05","Z68.25","F32.1","Z62.820","R55.","I08.1","S29.012A","S86.912A","G43.709","I87.392","R60.0","M79.89","F33.1","R07.89","J45.20","R42.","F41.9","M54.41","R00.2","R51.","M79.7","M62.838","G25.0","M54.2","G25.2","M48.02","G89.29","F43.10","G44.329","G43.109","M99.02","S16.1XXA","S29.019A","R20.9","R58.","I49.8","G44.321","S06.9X0A","Z11.59","F41.0","V89.2XXA","V49.50XA","M70.51","M17.11","F07.81","R68.89","Z68.30","R06.83","G47.9","G47.10","F32.9","S89.92XA","Z51.89","S01.402A","Z68.29","M22.2X1","L81.9","S71.112A","M79.639","NO DATA","W01.0XXA","R07.81","M99.09","G43.009","G44.209","Z91.81","Z48.02","F90.9","Z88.2","M54.5","M54.6","M79.605","R21.","I87.2","Z68.32","Z68.31","S80.01XA"],"date":["2020-04-21","2020-12-28","2020-06-23","2021-01-15","2021-01-15","2021-01-15","2021-01-15","2021-01-15","2020-06-23","2021-05-18","2021-05-18","2021-01-01","2020-12-21","2020-12-28","2020-12-28","2021-05-21","2021-03-22","2021-03-22","2021-03-22","2021-07-25","2020-04-07","2020-09-01","2020-04-24","2020-09-01","2020-09-01","2020-06-04","2020-09-04","2020-09-04","2020-09-04","2020-11-19","2020-11-19","2020-08-27","2020-09-01","2021-07-15","2020-11-19","2020-09-01","2020-08-22","2021-01-15","2020-10-30","2020-10-30","2020-05-09","2020-12-07","2021-02-04","2021-06-22","2021-05-25","2021-05-25","2020-05-14","2020-05-28","2020-05-28","2021-07-15","2021-07-15","2021-07-15","2021-07-15","2021-07-15","2020-05-04","2020-05-04","2020-05-04","2020-05-04","2020-12-05","2020-12-07","2020-12-07","2020-12-11","2021-08-16","2021-02-16","2020-12-06","2020-12-06","2020-12-06","2020-12-06","2021-01-15","2021-01-15","2020-11-30","2020-11-30","2020-12-21","2020-12-29","2020-12-29","2020-12-29","2021-01-21","2021-01-21","2021-01-21","2021-03-09","2021-03-09","2021-03-09","2021-06-22","2021-08-16"],"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":[["","60505025203","TIZANIDINE ","4MG","90","Select","Select",""],["","00378110101","PRAZOSIN ","1MG","30","Select","Select",""],["","62332011990","PREGABALIN ","25MG","60","Select","Select",""],["","00173068220","VENTOLIN ","","18","Select","Select",""],["","31722072610","MONTELUKAST ","10MG","30","Select","Select",""],["","16714029904","AMOXICILLIN ","500MG","21","Select","Select",""],["","16714053211","SUMATRIPTAN ","50MG","9","Select","Select",""],["","16714061305","SERTRALINE ","100MG","60","Select","Select",""],["","47335038383","DULOXETINE ","60MG","30","Select","Select",""],["","31722019301","OXYCOD\/APAP ","7.5-325","12","Select","Select",""],["","66993001968","ALBUTEROL ","HFA","18","Select","Select",""],["","68382080610","TRAZODONE ","100MG","30","Select","Select",""],["","33342008841","RIZATRIPTAN ","10MG","9","Select","Select",""],["","69452015120","VITAMIN ","50000UNT","8","Select","Select",""],["","16729013616","CLONAZEPAM ","0.5MG","60","Select","Select",""],["","00172409660","BACLOFEN ","10MG","90","Select","Select",""],["","16714045301","QUETIAPINE ","50MG","90","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","68382005105","MELOXICAM ","15MG","30","Select","Select",""],["","10702019001","HYDROCO\/APAP ","7.5-325","6","Select","Select",""],["","00603459315","METHYLPRED ","4MG","21","Select","Select",""],["","57664037713","TRAMADOL ","50MG","28","Select","Select",""],["","65162019011","NAPROXEN ","500MG","12","Select","Select",""],["","65162083366","DICLOFENAC ","1%","300","Select","Select",""],["","29300022701","METRONIDAZOL ","500MG","14","Select","Select",""],["","65862039010","ONDANSETRON ","4MG ODT","30","Select","Select",""],["","13668003105","TOPIRAMATE ","25MG","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","",""],["N\/A","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":""}]}]}