{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ROBERT ALLEN","gend":0,"add":"1331 SHAMROCK GARDEN RD APT 12","city":"CHESAPEAKE","state":"VA","zip":"23323-9998","dob":"1970-01-06","age":"","mstatus":"","insh":"20049994*01","cliId":"","pno":"757\/956-0345","cno":"757\/956-0345","email":"","ename":"","eno":"","pphy":"WELLS, JANELLE M MD","ppno":"757\/393-6363","pcpadd":"664 LINCOLN ST","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":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F31.32","F31.2","M54.40","Z72.0","L03.115","F10.20","M54.9","M54.16","NO DATA","M47.816","M51.37","M47.817","F43.21","Z59.0","V62.84","S00.03XA","F10.920","F17.210","M54.41","R41.82","R40.2422","S51.011A","S81.011A","S70.211A","S50.312A","S50.311A","S80.811A","R26.89","Z23.","Z87.81","M25.569","E78.5","R73.03","Z00.00","T14.90XA","S05.01XA","M25.511","M25.561","V58.89","S01.111A","W19.XXXA","S01.81XA","G89.29","M51.16","Z79.899","T07.XXXA","V01.931A"],"date":["2020-08-24","2020-12-06","2021-11-22","2021-11-24","2022-07-25","2022-10-19","2022-06-17","2022-07-18","2021-12-14","2022-07-18","2021-12-14","2021-12-14","2020-01-07","2020-01-07","2020-01-07","2020-05-29","2020-05-29","2022-01-31","2021-11-24","2022-07-15","2022-07-15","2022-07-15","2022-07-15","2022-07-15","2022-07-15","2022-07-15","2022-07-15","2022-07-15","2022-07-15","2022-07-15","2022-06-17","2022-06-17","2022-06-17","2022-06-17","2022-07-15","2022-07-20","2022-08-20","2022-07-16","2022-07-22","2020-02-11","2020-02-11","2020-05-29","2022-01-31","2022-01-31","2022-01-31","2022-07-15","2022-07-15"],"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":[]},{"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":[["","65162010211","GABAPENTIN","CAP 300MG","90","Select","Select",""],["","31604001724","FISH","CAP 1200MG","180","Select","Select",""],["","58160088752","FLUARIX","INJ 2021-22","0","Select","Select",""],["","51672400501","CARBAMAZEPIN","TAB 200MG","270","Select","Select",""],["","10572030201","PEG-3350\/KCL","SOL \/SODIUM","4000","Select","Select",""],["","61314062810","POLYMYXIN","SOL TRIMETHP","10","Select","Select",""],["","65862050320","AMOX\/K","TAB 875-125","20","Select","Select",""],["","31722099601","HYDROCO\/APAP","TAB 5-325MG","7","Select","Select",""],["","69584061150","METHOCARBAM","TAB 500MG","40","Select","Select",""],["","00904672040","ACETAMIN","TAB 500MG","60","Select","Select",""],["","00093342201","CYCLOBENZAPR","TAB 10MG","45","Select","Select",""],["","65162004710","OXYCODONE","TAB 5MG","25","Select","Select",""],["","59746017310","PREDNISONE","TAB 10MG","43","Select","Select",""],["","69547035302","NARCAN","SPR ","2","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":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"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":""}]}]}