{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TIERA  A BURWELL","gend":1,"add":"3422 BENNETT DR NW APT 11","city":"ROANOKE","state":"VA","zip":24017,"dob":"1992-06-02","age":"","mstatus":"","insh":"1535748*01","cliId":"","pno":"540\/525-2201","cno":"","email":"","ename":"","eno":"","pphy":"Route,  barbara","ppno":"540\/362-0360","pcpadd":"5424 Discovery Park Blvd BLDB A STE 201","pcpcity":"WILLIAMSBURG","pcpstate":"VA","pcpzip":24017,"pcpcounty":"","pcpid":"","pcpname":"KUUMBA COMMUNITY HEALTH AND WELLNESS CENTER INC","plan":"OHP","program":"Medicaid","lob":"M4","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"540\/362-5590","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N91.2","Z3A.01","R11.0","O26.892","Z3A.23","R51.9","N90.89","O36.8390","Z34.90","O99.891","R11.2","E87.6","M54.5","M54.9","F31.81","O80.","Z37.0","R07.89","M54.6","R42.","K80.20","Z33.1","O99.019","Z30.017","R10.12","F17.210","O48.0","O24.12","O98.32","O76.","O69.81X0","O99.02","Z20.822","E11.9","A60.00","D50.9","Z3A.41","Z87.891","Z83.3","Z86.32","M62.838","K21.9","F41.9","F31.9","O21.9","K80.70","Z3A.16","R07.9","M54.2","M25.569","M25.562","M25.462","M62.830","M25.512","F32.9","NO DATA","M62.81","R51.","R29.898","M23.92","S16.1XXA","F33.1","R19.7","E66.9","Z71.3","Z71.89","E87.2","E86.0","R82.4","F12.19","E66.3"],"date":["2020-09-28","2020-09-28","2021-12-13","2021-01-25","2021-01-25","2021-06-22","2021-03-16","2021-05-10","2021-05-10","2021-01-25","2022-02-19","2021-01-25","2021-06-22","2020-01-22","2021-06-17","2021-05-29","2021-05-30","2021-12-13","2021-12-13","2021-01-25","2021-03-15","2021-03-15","2021-03-15","2021-05-31","2021-12-13","2021-12-13","2021-05-29","2021-05-29","2021-05-30","2021-05-29","2021-05-29","2021-05-29","2021-05-29","2021-05-29","2021-05-30","2021-05-29","2021-05-30","2021-05-29","2021-05-29","2021-05-29","2021-12-20","2021-12-20","2021-03-26","2021-03-26","2020-12-08","2020-12-08","2020-12-08","2019-11-07","2019-11-22","2019-08-05","2019-10-04","2019-10-04","2019-01-29","2019-03-26","2019-03-28","2019-08-27","2019-11-22","2019-11-22","2019-08-13","2019-08-13","2019-10-31","2019-04-05","2019-12-16","2019-08-07","2019-08-07","2019-08-07","2022-02-19","2022-02-19","2022-02-18","2022-02-19","2022-02-19"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}}]},{"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":[]},{"a":[]},{"a":{"indx":[false,false],"comment":["",""],"score":["",""]}},{"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":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","00378247401","DICLOFEN","TAB 50MG","30","Select","Select",""],["","65162036111","FOLIC","TAB 1MG","30","Select","Select",""],["","00536100901","FERROUS","TAB 325MG","270","Select","Select",""],["","","METOCLOPRAM","TAB 10MG","","Select","Select",""],["","51672130406","TERCONAZOLE","CRE 0.004","45","Select","Select",""],["","31722070430","VALACYCLOVIR","TAB 500MG","60","Select","Select",""],["","50111033401","METRONIDAZOL","TAB 500MG","14","Select","Select",""],["","00093031401","KETOROLAC","TAB 10MG","15","Select","Select",""],["","10702000710","CYCLOBENZAPR","TAB 10MG","20","Select","Select",""],["","69842087651","CVS","TAB 325MG","60","Select","Select",""],["","57237016199","OMEPRAZOLE","CAP 20MG","60","Select","Select",""],["","65162019050","NAPROXEN","TAB 500MG","20","Select","Select",""],["","","DOCUSATE","CAP 100MG","","Select","Select",""],["","65862039010","ONDANSETRON","TAB 4MG ODT","6","Select","Select",""],["","","PRENATAL","CHW TAB","","Select","Select",""],["","","PROMETHAZINE","TAB 25MG","","Select","Select",""],["","","FLUZONE","INJ 2020-21","","Select","Select",""],["","51862006205","DIAZEPAM","TAB 2MG","30","Select","Select",""],["","71093014005","METHOCARBAM","TAB 500MG","40","Select","Select",""],["","67877032105","IBUPROFEN","TAB 800MG","15","Select","Select",""],["","49884093547","DICLOFENAC","GEL 0.01","100","Select","Select",""],["","53885013610","ONETOUCH","MIS LANCETS","100","Select","Select",""],["","42858010201","OXYCOD\/APAP","TAB 5-325MG","5","Select","Select",""],["","00603188016","LIDOCAINE","PAD 0.05","30","Select","Select",""],["","00378064110","PREDNISONE","TAB 10MG","12","Select","Select",""],["","00832105515","BACLOFEN","TAB 20MG","30","Select","Select",""]]}},{"a":[]},{"a":[]},{"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":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["1",""],"comment":["",""],"sub":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"comment":[["","","",""],[""],[""],[""],[""],[""]],"sub":[]}}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":[]}]},{"t":"Mini-Cog","q":[{"a":[]},{"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":"","a13":""}]}]}