{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DOMINIQUE   J BROWN","gend":1,"add":"1102 15TH ST APT A","city":"ROANOKE","state":"VA","zip":"24013-9998","dob":"1994-11-21","age":"","mstatus":"","insh":"20066407*01","cliId":"","pno":"540\/238-7836","cno":"540\/238-7836","email":"","ename":"","eno":"","pphy":"ROYALL, SABRINA FNP","ppno":"540\/362-0360","pcpadd":"3716 MELROSE AVE NW","pcpcity":"ROANOKE","pcpstate":"VA","pcpzip":24017,"pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"540\/362-5590","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F12.20","F41.8","Z30.45","F51.01","J06.9","A59.01","L30.9","Z30.016","Z11.3","F43.10","R53.83","S39.012A","Z20.2","Z11.4","Z11.59","N89.8","N76.0","B96.89","R10.2","N94.89","R11.2","E87.6","J02.9","Z87.891","R13.10"],"date":["2022-11-22","2021-04-29","2021-04-29","2021-04-29","2021-11-07","2022-01-20","2022-01-20","2021-01-19","2021-01-19","2020-06-24","2021-05-19","2021-05-19","2021-06-10","2021-06-10","2021-06-10","2020-06-08","2020-06-08","2020-06-08","2020-06-08","2020-10-19","2020-10-21","2020-10-21","2021-02-21","2021-02-21","2021-02-21"],"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":[["","57237007710","ONDANSETRON","TAB 4MG ODT","12","Select","Select",""],["","50111033402","METRONIDAZOL","TAB 500MG","14","Select","Select",""],["","67877025115","TRIAMCINOLON","CRE 0.001","15","Select","Select",""],["","67877032105","IBUPROFEN","TAB 800MG","30","Select","Select",""],["","52817033200","CYCLOBENZAPR","TAB 10MG","15","Select","Select",""],["","57237004105","PENICILLN","TAB 500MG","20","Select","Select",""],["","16729014501","QUETIAPINE","TAB 25MG","30","Select","Select",""],["","29300013601","CLONIDINE","TAB 0.2MG","60","Select","Select",""],["","00378334053","XULANE","DIS 150-35","3","Select","Select",""],["","59267100001","PFIZER","INJ COVID-19","0","Select","Select",""],["","00574018101","POT  CHLORIDE","CAP 10MEQ ER","7","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":""}]}]}