{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TIYONNA ROZZELL","gend":1,"add":"508 BUNCHE BLVD APT 102","city":"PORTSMOUTH","state":"VA","zip":"23701-9998","dob":"2003-09-30","age":"","mstatus":"","insh":"8922381*01","cliId":"","pno":"757\/735-3518","cno":"","email":"","ename":"","eno":"","pphy":"RODRIGUEZ, HIRAM J MD","ppno":"757\/547-0688","pcpadd":"705 BATTLEFIELD BOULEVARD","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":23320,"pcpcounty":"","pcpid":"","pcpname":"PATIENT FIRST RICHMOND MEDICAL GROUP PLLC","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/547-2902","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["L30.9","L81.0","N76.2","N89.8","Z23.","Z20.828","R00.2","I49.9","I47.1","E66.3","R07.2","Z86.79","R07.89","Z79.1","N76.0","N92.0","Z97.5","N64.52","Z98.890","Z30.017","E28.2","N91.4","Z00.121","Z13.31","J02.9","R05.","R51.","R09.81","J45.30","J30.2","S61.318A","R00.0"],"date":["2020-12-02","2020-12-02","2020-03-11","2020-03-11","2021-02-13","2021-01-22","2021-10-27","2021-07-03","2021-10-27","2021-08-27","2021-10-27","2021-07-13","2021-10-27","2021-10-27","2020-02-26","2020-02-26","2020-02-26","2020-11-02","2021-08-28","2019-07-10","2019-01-30","2019-01-30","2019-10-01","2019-10-01","2019-01-22","2019-01-22","2019-01-22","2019-01-22","2019-03-12","2019-03-12","2019-09-27","2021-07-03"],"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":[["","","FLUCONAZOLE","TAB 150MG","","Select","Select",""],["","00187137326","CERAVE","CRE ","113","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","17","Select","Select",""],["","","NYSTAT\/TRIAM","OIN ","","Select","Select",""],["","00173068220","VENTOLIN","AER ","36","Select","Select",""],["","","NYSTATIN","OIN 100000","","Select","Select",""],["","00173071820","FLOVENT","AER 44MCG","11","Select","Select",""],["","59310057922","PROAIR","AER ","17","Select","Select",""],["","","HYDROCORT","CRE 0.025","","Select","Select",""],["","00378363705","CETIRIZINE","TAB 10MG","30","Select","Select",""],["","00135057602","FLONASE","SPR 50MCG","10","Select","Select",""],["","60505082901","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","00085113204","PROVENTIL","AER HFA","13","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":""}]}]}