{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"B YDOCTIONE","gend":0,"add":"UD 402TS NN","city":"CHESAPEAKE","state":"VA","zip":"23320-9998","dob":"1998-02-25","age":"","mstatus":"","insh":"83200210*92","cliId":"","pno":"36\/7576698-6","cno":"","email":"","ename":"","eno":"","pphy":"CONROY, ASHLEY NP","ppno":"757\/935-5310","pcpadd":"3060 GODWIN BLVD","pcpcity":"SUFFOLK","pcpstate":"VA","pcpzip":23434,"pcpcounty":"","pcpid":"","pcpname":"BAYVIEW PHYSICIAN SERVICES PC","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z01.812","Z20.822","M54.2","M54.9","Z88.0","Z88.1","B35.1","L60.8","B35.3","M79.609","Z20.828","K12.0","Z11.1","J45.40","M54.42","M54.41","M54.16","M46.1","M51.37","J01.00","J40.","J02.9","Z11.59","R06.02","R10.9","R11.10","R53.1","J30.1","J30.89","F42.9","N30.00","R10.33","R10.31","G43.809","R20.0","G43.909","NO DATA","F32.9","F10.10","R05.","R07.0","Z87.39","Z76.89","J45.901","S46.211A","S83.191A","S83.31XA","M25.561","S89.91XS","G44.209","F44.9","J45.50","R20.2","R06.00","R07.9","S06.0X0A","R10.32","L02.214","B34.9","M26.609","Z28.21","M51.26","H91.93","F17.210","M22.41","S43.401A","W19.XXXA","H10.9","L23.9","R11.2","Z23.","F84.5","F41.9","Z79.51","Z79.899","K52.9","M25.511","S29.019A","S39.012A","R00.0","S93.601A","J20.9","J45.21","H04.123","M54.5","G89.29","J06.9","J03.90","R13.10","R53.83","Z84.0","Z82.5","Z84.89","G89.21","S96.911A","S90.31XA"],"date":["2021-03-07","2021-03-07","2021-07-28","2021-07-28","2021-07-28","2021-07-28","2021-08-02","2021-08-02","2021-08-02","2021-08-02","2021-01-09","2020-10-05","2020-10-05","2021-03-10","2021-06-26","2021-06-25","2020-05-18","2020-05-18","2020-05-18","2021-07-10","2021-07-10","2020-03-10","2020-03-10","2020-08-17","2020-03-10","2020-03-10","2020-03-10","2020-05-18","2020-05-18","2020-05-18","2020-11-29","2020-11-29","2020-11-29","2020-03-01","2020-03-01","2020-06-05","2020-03-09","2020-03-09","2020-06-05","2020-08-07","2020-08-07","2021-07-28","2021-07-28","2020-01-15","2020-05-14","2020-05-14","2020-05-14","2020-12-05","2020-12-05","2021-02-21","2021-02-21","2021-03-10","2020-03-03","2020-03-03","2020-03-03","2020-05-13","2020-06-25","2020-06-25","2021-01-13","2021-02-26","2021-02-26","2020-06-05","2020-06-05","2020-06-05","2020-12-11","2021-06-13","2021-06-26","2020-04-06","2020-04-06","2020-04-26","2019-01-09","2019-11-25","2019-11-25","2019-11-25","2019-11-25","2019-01-09","2019-07-23","2019-01-17","2019-01-17","2019-01-17","2019-05-10","2019-10-03","2019-10-03","2019-05-24","2019-08-03","2019-08-03","2019-12-09","2019-05-08","2019-05-08","2019-05-09","2019-05-09","2019-05-09","2019-05-09","2019-01-19","2019-05-03","2019-05-03"],"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":[["","59310057922","PROAIR","AER ","8","Select","Select",""],["","68462019005","NAPROXEN","TAB 500MG","60","Select","Select",""],["","74312019939","D3","CAP 2000UNIT","90","Select","Select",""],["","80777027399","MODERNA","INJ COVID-19","0","Select","Select",""],["","68682010301","DICLOFENAC","TAB 100MG ER","30","Select","Select",""],["","00378064110","PREDNISONE","TAB 10MG","26","Select","Select",""],["","65862007930","TERBINAFINE","TAB 250MG","30","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","18","Select","Select",""],["","59746000103","METHYLPRED","TAB 4MG","21","Select","Select",""],["","00310737020","BUDES\/FORMOT","AER 160-4.5","10","Select","Select",""],["","00173068220","VENTOLIN","AER ","18","Select","Select",""],["","00186037020","SYMBICORT","AER 160-4.5","20","Select","Select",""],["","52817033200","CYCLOBENZAPR","TAB 10MG","30","Select","Select",""],["","17478071710","KETOTIF","DRO 0.025%OP","5","Select","Select",""],["","24658031205","DOXYCYCL","TAB 100MG","20","Select","Select",""],["","69584061150","METHOCARBAM","TAB 500MG","20","Select","Select",""],["","70461032103","FLUCLVX","INJ 2021-22","0","Select","Select",""],["","00781808926","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","53746010901","HYDROCO\/APAP","TAB 5-325MG","20","Select","Select",""],["","67877057505","BENZONATATE","CAP 200MG","21","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":""}]}]}