{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CYNTHIA   C GALLASHAW","gend":1,"add":"1600 SOUTH ST APT 209","city":"PORTSMOUTH","state":"VA","zip":"23704-9998","dob":"1960-04-13","age":"","mstatus":"","insh":"2172837*01","cliId":"","pno":"757\/450-1514","cno":"757\/450-1514","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":"M4","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":["I63.411","G81.94","E66.01","I10.","E78.5","Z68.43","Z87.891","J45.909","I63.9","R53.1","I69.398","Z68.44","R07.9","R42.","D64.9","Z86.39","E87.6","E78.00","E55.9","J45.40","I63.511","I67.89","I69.354","I69.322","I69.391","R13.12","Z79.82","Z79.01","N28.9","Z74.09","Z79.899","E78.2","I63.419","R47.1","R73.9","E16.2","R29.810","Z79.02","Z91.19","I67.2","I67.81","I69.352","D63.8","N95.0","Z78.0","Z68.41","R13.10","R29.705","Z23.","Z82.3","I69.30","R47.9","R26.9","R29.90","I63.311","F43.21","I63.50"],"date":["2020-11-21","2021-11-09","2021-11-12","2021-11-19","2021-11-12","2021-10-15","2021-11-12","2021-11-12","2021-11-09","2021-10-15","2020-11-27","2021-11-12","2021-10-15","2021-10-19","2021-11-12","2021-11-08","2021-11-12","2021-11-09","2021-11-12","2021-11-19","2021-10-17","2021-11-09","2021-11-12","2021-11-12","2021-11-12","2021-11-12","2021-11-12","2021-11-12","2021-10-15","2021-10-19","2021-10-19","2021-11-19","2021-11-19","2021-10-15","2021-10-15","2021-10-15","2021-10-15","2021-10-15","2021-10-15","2021-10-16","2021-10-23","2021-10-23","2021-10-23","2021-11-19","2021-11-19","2020-11-21","2020-11-21","2020-11-21","2020-11-21","2020-11-21","2020-11-21","2020-11-21","2020-11-21","2020-11-21","2020-11-23","2021-10-20","2020-11-21"],"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":[["","68645059459","FAMOTIDINE","TAB 20MG","30","Select","Select",""],["","00904759080","FEROSUL","TAB 325MG","90","Select","Select",""],["","80681017401","VITAMIN","CAP 1.25MG","12","Select","Select",""],["","16729032010","OLMESA","TAB 5MG","30","Select","Select",""],["","00093505798","ATORVASTATIN","TAB 80MG","30","Select","Select",""],["","68645059090","CLOPIDOGREL","TAB 75MG","21","Select","Select",""],["","69315012710","FOLIC","TAB 1000MCG","30","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","57896070310","IRON","TAB 325MG","30","Select","Select",""],["","68645051654","AMLODIPINE","TAB 10MG","30","Select","Select",""],["","81131009371","SV","TAB 325MG","30","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","26","Select","Select",""],["","54629797430","COENZYME","CAP 100MG","30","Select","Select",""],["","49348075707","SM","CHW 81MG","60","Select","Select",""],["","31722070290","LOSARTAN","TAB 100MG","30","Select","Select",""],["","43598071901","CHLORTHALID","TAB 25MG","30","Select","Select",""],["","57237010099","METOPROL","TAB 25MG","60","Select","Select",""],["","00904404073","ASPIRIN","CHW 81MG","60","Select","Select",""],["","66993058597","FLUTIC\/SALME","AER 250\/50","60","Select","Select",""],["","00173069600","ADVAIR","AER 250\/50","60","Select","Select",""],["","81131031250","MELATONIN","TAB 3MG","90","Select","Select",""],["","81131057368","Q-SORB","CAP 100MG","90","Select","Select",""],["","49035072212","EQ","TAB 325MG EC","90","Select","Select",""],["","00093720110","PRAVASTATIN","TAB 20MG","30","Select","Select",""],["","68645051054","HYDROCHLOROT","TAB 25MG","30","Select","Select",""],["","68645055354","LISINOPRIL","TAB 20MG","30","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":""}]}]}