{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SASHA L BROWN","gend":1,"add":"5 SUBURBAN CIR APT C","city":"PORTSMOUTH","state":"VA","zip":"23702-9998","dob":"1986-12-09","age":"","mstatus":"","insh":"1428945*01","cliId":"","pno":7572735737,"cno":7572735737,"email":"","ename":"","eno":"","pphy":"MARKOVIC, VLADIMIR MD","ppno":7575339108,"pcpadd":"155 KINGSLEY LANE SUITE 320,","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":"23505-9998","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":7576226384,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K51.918","K63.2","K50.90","K21.9","Z86.2","Z79.899","R10.9","K50.10","K52.9","R11.10","R06.02","K50.80","R93.3","Z51.81","M79.605","Z98.890","K63.89","K92.2","M54.42","Z87.440","M54.32","R00.1","K50.113","R19.8","R10.31","K08.89","R22.0"],"date":["2021-11-24","2021-09-12","2022-09-19","2023-06-15","2022-01-15","2023-06-15","2021-09-12","2023-06-15","2022-01-15","2022-01-15","2022-01-16","2022-01-26","2021-04-06","2021-04-06","2022-01-12","2021-11-18","2021-11-18","2021-11-18","2022-09-19","2022-09-19","2022-09-19","2021-04-02","2021-09-20","2021-09-20","2022-01-11","2023-06-15","2023-06-15"],"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":[["","59746017509","PREDNISONE","TAB 20MG","14","Select","Select",""],["","55111015330","ONDANSETRON","TAB 4MG","12","Select","Select",""],["","00406051201","OXYCOD\/APAP","TAB 5-325MG","14","Select","Select",""],["","31722099601","HYDROCO\/APAP","TAB 5-325MG","10","Select","Select",""],["","50111033402","METRONIDAZOL","TAB 500MG","14","Select","Select",""],["","29300041519","CYCLOBENZAPR","TAB 10MG","20","Select","Select",""],["","00093031401","KETOROLAC","TAB 10MG","20","Select","Select",""],["","10135012301","ACETAMIN","TAB 325MG","20","Select","Select",""],["","59746017509","PREDNISONE TAB","20MG","14","Select","Select",""],["","55111015330","ONDANSETRON TAB","4MG","12","Select","Select",""],["","50111033402","METRONIDAZOL TAB","500MG","21","Select","Select",""],["","31722099601","HYDROCO\/APAP TAB","5-325MG","10","Select","Select",""],["","00093031401","KETOROLAC TAB","10MG","20","Select","Select",""],["","10135012301","ACETAMIN TAB","325MG","20","Select","Select",""],["","29300041519","CYCLOBENZAPR TAB","10MG","20","Select","Select",""],["","00116200116","CHLORHEXIDINE GLUCONATE","0.12 %","473","Select","Select",""],["","00406012301","HYDROCODONE-ACETAMINOPHEN","5 MG-325MG","9","Select","Select",""],["","65862017601","PENICILLIN V POTASSIUM","500 MG","28","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":""}]}]}