{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TERESEA   R SOLOMAN","gend":1,"add":"422 FOX HILL RD UNIT B","city":"HAMPTON","state":"VA","zip":"23669-9998","dob":"1984-07-17","age":"","mstatus":"","insh":"20063669*01","cliId":"","pno":"757\/381-7647","cno":"","email":"","ename":"","eno":"","pphy":"ARNOLD, HELEN G DO","ppno":"757\/930-0091","pcpadd":"12715 WARWICK BLVD STE O","pcpcity":"NEWPORT NEWS","pcpstate":"VA","pcpzip":23606,"pcpcounty":"","pcpid":"","pcpname":"Commonwealth Family Practice","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/269-4406","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F43.10","F33.1","F41.1","J18.9","J45.901","R06.00","R06.4","Z20.828","F90.2","F33.0","R07.9","S63.631A","F90.9","M79.603","R53.1","R06.02","H10.31","L03.115","M25.512","M54.2","M79.622","R07.89","I49.8","I10.","J45.909","F17.200","Z79.899","M62.838","M79.602","F33.3"],"date":["2022-07-17","2022-04-23","2022-03-13","2020-11-14","2020-11-14","2020-11-14","2020-11-14","2020-11-14","2022-08-22","2020-08-09","2021-12-27","2020-01-16","2020-03-09","2021-12-27","2021-12-27","2020-11-15","2021-06-26","2021-02-20","2021-12-27","2021-12-27","2021-12-27","2021-12-27","2021-12-27","2021-12-27","2021-12-27","2021-12-27","2021-12-27","2021-12-27","2021-12-27","2022-07-17"],"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":[["","42806034301","AMPHET\/DEXTR","TAB 15MG","30","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","20","Select","Select",""],["","60505003901","ETODOLAC","CAP 200MG","20","Select","Select",""],["","68645056259","IBUPROFEN","TAB 600MG","20","Select","Select",""],["","00574402435","ERYTHROMYCIN","OIN 5MG\/GM","4","Select","Select",""],["","57844011001","ADDERALL","TAB 10MG","60","Select","Select",""],["","52817033050","CYCLOBENZAPR","TAB 5MG","20","Select","Select",""],["","65162019011","NAPROXEN","TAB 500MG","20","Select","Select",""],["","00591352530","LIDOCAINE","PAD 0.05","15","Select","Select",""],["","68645055254","LISINOPRIL","TAB 10MG","30","Select","Select",""],["","","ATOMOXETINE","CAP 40MG","","Select","Select",""],["","","AZITHROMYCIN","TAB 250MG","","Select","Select",""],["","","PROAIR","AER ","","Select","Select",""],["","","ALBUTEROL","AER HFA","","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":""}]}]}