{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ROBBIN  S FARMER","gend":1,"add":"507 AVONDALE RD APT E","city":"PORTSMOUTH","state":"VA","zip":"23701-9998","dob":"1979-12-29","age":"","mstatus":"","insh":"8102686*01","cliId":"","pno":7574931181,"cno":7574931181,"email":"","ename":"","eno":"","pphy":"TUCKER, MICHAEL MD","ppno":7576253777,"pcpadd":"110 KINGSLEY LANE SUITE 411,","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":"23505-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7576257411,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N62.","I10.","J32.9","E66.01","K91.2","L98.7","Z68.41","Z98.84","Z71.3","J30.1","J32.0","L24.0","M19.90","Z79.899","Z68.34","R21.","Z00.00","E66.9","F41.9","D51.0","E55.9","E78.2","M79.642","R03.0","R63.5","R14.0","R10.13","M54.9","J06.9","Z01.812","Z20.822"],"date":["2021-06-09","2023-05-30","2023-02-28","2022-11-14","2022-11-14","2022-11-14","2022-11-14","2022-11-14","2022-11-14","2023-03-31","2023-03-31","2021-02-06","2021-02-06","2021-02-06","2021-03-01","2021-02-06","2022-03-29","2021-12-02","2021-12-02","2021-08-10","2022-11-14","2022-11-14","2023-01-02","2023-01-02","2022-04-04","2022-04-04","2022-04-04","2023-05-30","2022-11-14","2021-06-02","2021-06-02"],"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":[["","69452015120","VITAMIN D CAP","50000UNT","4","Select","Select",""],["","00574200802","NYSTOP POW","100000","60","Select","Select",""],["","00781207410","TRIAMT\/HCTZ CAP","37.5-25","90","Select","Select",""],["","10702002501","PHENTERMINE TAB","37.5MG","30","Select","Select",""],["","65862042005","SMZ\/TMP DS TAB","800-160","14","Select","Select",""],["","00832046560","NYAMYC POW","100000","60","Select","Select",""],["","68308015260","NYSTATIN POW","100000","60","Select","Select",""],["","42806040021","METHYLPRED TAB","4MG","21","Select","Select",""],["","00904675180","ASPIRIN EC","81 MG","30","Select","Select",""],["","00781185220","AMOXICILLIN-CLAVULANATE POTASS","875-125 MG","28","Select","Select",""],["","10135012310","ACETAMINOPHEN","325 MG","20","Select","Select",""],["","60505082901","FLUTICASONE PROPIONATE","50 MCG","16","Select","Select",""],["","16571082230","LORATADINE","10 MG","90","Select","Select",""],["","00054418425","DEXAMETHASONE","4 MG","15","Select","Select",""],["","31722088490","ROSUVASTATIN CALCIUM","20 MG","90","Select","Select",""],["","41100081092","CLARITIN","10 MG","90","Select","Select",""],["","70010075401","METHOCARBAMOL","500 MG","30","Select","Select",""],["","57896020110","PAIN RELIEF","500 MG","120","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":""}]}]}