{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ASHLEY   A ASHBROOK","gend":1,"add":"1017 23RD ST LOT 144","city":"NEWPORT NEWS","state":"VA","zip":"23607-9998","dob":"1990-03-02","age":"","mstatus":"","insh":"1839923*01","cliId":"","pno":"757\/604-4470","cno":"","email":"","ename":"","eno":"","pphy":"RICASA, JOCELYN MD","ppno":"757\/673-5680","pcpadd":"828 HEALTHY WAY STE 220B","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23462,"pcpcounty":"","pcpid":"","pcpname":"BON SECOURS MEDICAL ASSOCIATES","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/673-5682","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G89.29","M54.5","M96.1","M51.16","Z98.890","M51.26","Z30.46","F41.9","Z30.015","R03.0","F32.1","F43.10","M25.372","M25.572","M53.3","M47.26","E66.01","M62.838","Z79.899","Z88.8","Z68.41","M54.41","M51.36","J11.1","M47.816","M54.16","M54.31","R20.2","E55.9","R68.89","Z00.00","NO DATA"],"date":["2020-12-17","2020-09-02","2020-12-17","2020-12-17","2020-12-17","2021-04-13","2021-08-06","2021-09-27","2021-08-06","2021-09-27","2021-09-27","2021-09-27","2019-01-22","2019-01-22","2019-05-09","2020-12-17","2020-12-15","2019-05-09","2019-05-09","2019-05-09","2020-12-15","2020-12-17","2020-12-17","2020-03-17","2020-12-17","2020-09-24","2021-01-17","2021-08-15","2020-12-15","2020-12-15","2020-12-15","2020-09-24"],"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":[["","","CYCLOBENZAPR"," CYCLOBENZAPR ","30","Select","Select",""],["","","DICLOFENAC"," DICLOFENAC ","20","Select","Select",""],["","","HYDROCO\/APAP"," HYDROCO\/APAP ","20","Select","Select",""],["","","OXYCOD\/APAP"," OXYCOD\/APAP ","30","Select","Select",""],["","","CEPHALEXIN"," CEPHALEXIN ","30","Select","Select",""],["","","METHYLPRED"," METHYLPRED ","21","Select","Select",""],["","","APAP\/CODEINE"," APAP\/CODEINE ","12","Select","Select",""],["","","NAPROXEN"," NAPROXEN ","20","Select","Select",""],["","","TRAMADOL"," TRAMADOL ","20","Select","Select",""],["","","LORAZEPAM"," LORAZEPAM ","2","Select","Select",""],["","","TIZANIDINE","TAB 4MG","","Select","Select",""],["","","MELOXICAM","TAB 15MG","","Select","Select",""],["","","TOPIRAMATE","TAB 50MG","","Select","Select",""],["","","METHOCARBAM","TAB 500MG","","Select","Select",""],["","","PREDNISONE","TAB 10MG","","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":[]}},{"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":""}]}]}