{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TAMEKA  D JACKSON","gend":1,"add":"607 JEFFERSON ST C","city":"PORTSMOUTH","state":"VA","zip":"23704-9998","dob":"1974-04-22","age":"","mstatus":"","insh":"2474719*01","cliId":"","pno":7572325499,"cno":7572325499,"email":"","ename":"","eno":"","pphy":"ROSENBERG, DAVID MD","ppno":7573936363,"pcpadd":"1541 HIGH ST,","pcpcity":"PORTSMOUTH","pcpstate":"VA","pcpzip":"23704-9998","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":7573970047,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M25.775","M77.42","M20.42","Z23.","I10.","E78.5","Z21.","Z09.","Z86.2","E05.90","Z79.1","Z79.899","Z79.2","B20.","Z78.9","M77.12","M25.522","R20.0","M79.642","R20.2","I50.22","R68.2","M79.605","L02.414","S50.862A","W57.XXXA","Z68.24","Z01.818","E04.9","I70.222","E55.9","T14.8XXA"],"date":["2021-07-02","2021-07-02","2021-07-02","2022-03-16","2022-12-06","2022-09-06","2022-06-16","2021-09-29","2021-09-29","2022-12-06","2021-09-29","2021-09-29","2021-09-29","2022-03-16","2022-03-16","2021-09-02","2021-09-02","2021-09-17","2021-09-02","2021-09-17","2022-09-06","2022-09-06","2021-07-02","2021-09-30","2021-09-30","2021-09-30","2021-09-30","2021-06-25","2022-12-06","2021-07-01","2021-09-27","2021-09-27"],"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":[["","80777027399","MODERNA VAC","INJ COVID-19","0","Select","Select",""],["","00228257111","INDAPAMIDE","2.5 MG","60","Select","Select",""],["","16729022501","SPIRONOLACT","TAB 25MG","90","Select","Select",""],["","68180072103","AMLODIPINE","TAB 10MG","90","Select","Select",""],["","49702023113","TRIUMEQ","600-50-300","30","Select","Select",""],["","65862029590","ROSUVASTATIN","TAB 20MG","90","Select","Select",""],["","00781261305","AMOXICILLIN","CAP 500MG","28","Select","Select",""],["","70377000812","ROSUVASTATIN CALCIUM","20 MG","90","Select","Select",""],["","80777027399","MODERNA VAC INJ COVID-","19","0","Select","Select",""],["","62559051101","INDAPAMIDE TAB","2.5MG","90","Select","Select",""],["","16729022501","SPIRONOLACT TAB","25MG","90","Select","Select",""],["","68180072103","AMLODIPINE TAB","10MG","90","Select","Select",""],["","49702023113","TRIUMEQ TAB","","30","Select","Select",""],["","65862029590","ROSUVASTATIN TAB","20MG","90","Select","Select",""],["","00781261305","AMOXICILLIN CAP","500MG","28","Select","Select",""],["","68645051654","AMLODIPINE BESYLATE","10 MG","90","Select","Select",""],["","33342033215","TRIAMCINOLONE ACETONIDE","0.5 %","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":""}]}]}