{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"RICHARD   W PEMBROKE","gend":0,"add":"1809 SHELL DRAKE CT TRLR 150","city":"CHESAPEAKE","state":"VA","zip":"23320-9998","dob":"1983-11-26","age":"","mstatus":"","insh":"20038593*01","cliId":"","pno":"757\/790-7146","cno":"","email":"","ename":"","eno":"","pphy":"ROSENBERG, DAVID MD","ppno":"757\/393-6363","pcpadd":"664 LINCOLN STREET","pcpcity":"PORTSMOUTH","pcpstate":"VA","pcpzip":23704,"pcpcounty":"","pcpid":"","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":["F20.0","F20.9","R44.0","Z91.14","F33.3","F12.10","F10.10","F12.20","Z20.828","R11.0","K04.7","J41.0","K12.1","Z72.0","I88.9","J45.20","J45.901","F17.200","A04.72","B34.9","K08.89","F11.20","F14.20","F31.63","F41.9","F19.10","F51.05","Z20.822","F29.","F10.20","K04.01","Z87.891","Z88.5","K13.79","F31.9","F17.210","R05."],"date":["2021-09-28","2021-05-13","2020-04-28","2020-04-28","2021-05-18","2021-09-28","2021-12-05","2021-08-24","2021-09-09","2021-09-09","2021-06-24","2021-02-02","2021-02-02","2021-02-02","2021-02-02","2020-12-09","2021-06-24","2021-06-24","2021-06-24","2021-08-16","2021-08-16","2021-04-06","2021-04-06","2021-09-09","2021-09-09","2021-09-09","2021-09-09","2021-11-05","2020-04-30","2021-02-17","2020-08-14","2020-08-14","2020-08-14","2020-08-14","2020-12-29","2021-03-02","2021-03-02"],"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":[["","","PROAIR","AER ","","Select","Select",""],["","","AMOXICILLIN","TAB 500MG","","Select","Select",""],["","","BENZTROPINE","TAB 1MG","","Select","Select",""],["","","OLANZAPINE","TAB 5MG","","Select","Select",""],["","","BUPROPION","TAB 100MG SR","","Select","Select",""],["","","MIRTAZAPINE","TAB 15MG","","Select","Select",""],["","08373747800","OPTICHAMBER","MIS DIAMOND","1","Select","Select",""],["","","ALBUTEROL","AER HFA","","Select","Select",""],["","","IBUPROFEN","TAB 800MG","","Select","Select",""],["","42571016242","AMOX\/K","TAB 875-125","20","Select","Select",""],["","00173068220","VENTOLIN","AER ","54","Select","Select",""],["","00093005301","BUSPIRONE","TAB 5MG","30","Select","Select",""],["","00603533932","PREDNISONE","TAB 20MG","21","Select","Select",""],["","","IPRATROPIUM\/","SOL ALBUTER","","Select","Select",""],["","68462019005","NAPROXEN","TAB 500MG","20","Select","Select",""],["","11822222590","RA","DIS 21MG\/24H","28","Select","Select",""],["","","CLINDAMYCIN","CAP 300MG","","Select","Select",""],["","","PALIPERIDONE","TAB ER 1.5MG","","Select","Select",""],["","","NICOTINE","DIS 21MG\/24H","","Select","Select",""],["","","PENICILLN","TAB 500MG","","Select","Select",""],["","","HYDROXYZ","TAB 25MG","","Select","Select",""],["","","INVEGA","TAB 1.5MG","","Select","Select",""],["","","HALOPERIDOL","TAB 5MG","","Select","Select",""],["","","AEROECLIPSE","MIS II NEB","","Select","Select",""],["","","TERBINAFINE","CRE 0.01","","Select","Select",""],["","","NICODERM","DIS 21MG\/24H","","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":""}]}]}