{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TERRY   A ROBINSON","gend":0,"add":"58 HALF MILE LN","city":"FRIES","state":"VA","zip":"24330-9998","dob":"1970-04-14","age":"","mstatus":"","insh":"2192421*01","cliId":"","pno":"276\/233-6436","cno":"","email":"","ename":"","eno":"","pphy":"FOWLER, SCOTT M MD","ppno":"276\/773-2063","pcpadd":"217 S INDEPENDENCE AVE","pcpcity":"INDEPENDENCE","pcpstate":"VA","pcpzip":24348,"pcpcounty":"","pcpid":"","pcpname":"SRMHMG - Sentara East Market Street Health Center","plan":"OHP","program":"MEDICAID","lob":"M4","region":"SOUTHWEST","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"276\/773-2118","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J01.40","R68.89","M77.9","I50.23","Z76.89","I48.91","E66.9","Z86.79","I10.","I50.21","F17.200","I48.0","I50.42","R73.9","E78.2","Z72.0","F41.8","Z13.220","Z79.01","Z13.29","M77.8","Z79.899","Z72.89","Z83.3","Z82.49","M25.531","M79.605","V89.2XXA","R73.01","NO DATA","F39.","S39.012A","M43.06","X50.0XXA"],"date":["2020-03-13","2020-09-29","2021-10-25","2021-05-04","2021-05-04","2021-06-03","2021-05-04","2021-05-04","2021-10-04","2021-05-04","2021-05-04","2021-10-04","2021-10-04","2021-07-21","2021-07-21","2021-10-04","2020-02-11","2020-09-29","2021-10-25","2020-09-29","2021-10-25","2021-10-25","2021-10-25","2021-10-25","2021-10-25","2021-10-25","2021-11-22","2021-11-22","2021-10-04","2021-10-04","2021-10-04","2019-12-04","2019-12-04","2019-12-04"],"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":[["","","ALBUTEROL","AER HFA","","Select","Select",""],["","00003089421","ELIQUIS","TAB 5MG","60","Select","Select",""],["","","PROAIR","AER ","","Select","Select",""],["","","BUSPIRONE","TAB 10MG","","Select","Select",""],["","00378021610","FUROSEMIDE","TAB 40MG","30","Select","Select",""],["","00245531911","KLOR-CON","TAB 20MEQ ER","60","Select","Select",""],["","","CETIRIZINE","TAB 10MG","","Select","Select",""],["","50742061710","METOPROL","TAB 100MG ER","30","Select","Select",""],["","59746000103","METHYLPRED","TAB 4MG","21","Select","Select",""],["","13668000905","CITALOPRAM","TAB 10MG","30","Select","Select",""],["","65162018910","NAPROXEN","TAB 375MG","20","Select","Select",""],["","","CVS","TAB 10MG","","Select","Select",""],["","68180051303","LISINOPRIL","TAB 5MG","30","Select","Select",""],["","13668013601","ESCITALOPRAM","TAB 10MG","30","Select","Select",""],["","","CEPHALEXIN","CAP 500MG","","Select","Select",""],["","","VENTOLIN","AER ","","Select","Select",""],["","","POT  CL MICRO","TAB 20MEQ ER","","Select","Select",""],["","10702001150","HYDROXYZ","TAB 25MG","30","Select","Select",""],["","00172392670","DIAZEPAM","TAB 5MG","7","Select","Select",""],["","71093014005","METHOCARBAM","TAB 500MG","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":[]}},{"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":""}]}]}