{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LORY   A LAWSON","gend":1,"add":"3503 FAIRFAX DR","city":"HAMPTON","state":"VA","zip":"23661-9998","dob":"1953-09-04","age":"","mstatus":"","insh":"900038113*01","cliId":"7K01YK5CJ26","pno":"757\/722-7709","cno":"757\/722-7709","email":"","ename":"","eno":"","pphy":"BOYER, DEBRA MD","ppno":"757\/850-1311","pcpadd":"191 FOX HILL ROAD STE D","pcpcity":"HAMPTON","pcpstate":"VA","pcpzip":23669,"pcpcounty":"","pcpid":118380,"pcpname":"Elizabeth Lakes Family Practice","plan":"OHP","program":"MEDICARE","lob":"MA-Non DSNP","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/850-7315","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E87.6","E83.42","F10.10","R74.8","E78.00","E55.9","L30.9","I10.","F17.210","E78.5","F33.0","R73.03","D51.8","J06.9","R11.0","H40.013","E11.9","H43.393","H25.13","H04.123","H01.02A","H01.02B","H52.03","H52.223","H52.4","Z12.2","N20.2","Z12.31","Z72.89","R31.0","R42.","R68.89","Z00.00"],"date":["2020-09-24","2020-09-24","2020-06-24","2020-06-24","2020-06-24","2020-09-24","2020-09-24","2020-09-24","2020-09-24","2020-09-24","2020-09-24","2020-09-24","2020-09-24","2020-03-11","2020-03-11","2020-06-15","2020-06-15","2020-06-15","2020-06-15","2020-06-15","2020-06-15","2020-06-15","2020-06-15","2020-06-15","2020-06-15","2020-08-05","2020-02-05","2020-08-05","2020-01-24","2020-01-24","2020-01-24","2020-01-24","2020-06-24"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}},{"a":[]}]},{"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":[]}]},{"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":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","00603020922","MAG ","400MG","30","Select","Select",""],["","68180095602","CLOBETASOL ","0.05%","30","Select","Select",""],["","70377002911","ATORVASTATIN ","40MG","30","Select","Select",""],["","70436000203","POT  CHLORIDE","10MEQ ER","30","Select","Select",""],["","69097083512","SERTRALINE ","100MG","90","Select","Select",""],["","68462010530","ONDANSETRON ","4MG","20","Select","Select",""],["","68180072103","AMLODIPINE ","10MG","90","Select","Select",""],["","53489011905","DOXYCYCL ","100MG","14","Select","Select",""],["","68180016013","AZITHROMYCIN ","250MG","6","Select","Select",""],["","50428037624","VITAMIN ","1000MCG","90","Select","Select",""],["","59779001922","ALLERGY ","25MG","30","Select","Select",""],["","67877056105","METFORMIN ","500MG","30","Select","Select",""],["","68462029817","CLOTRIM\/BETA ","DIPROP","45","Select","Select",""],["","70377002911","","40MG","30","Select","Select",""],["","70377002911","ATORVASTATIN","40MG","30","Select","Select",""],["","68180095602","CLOBETASOL","0.05%","30","Select","Select",""],["","68180072103","AMLODIPINE","10MG","90","Select","Select",""],["","00603020922","MAG","400MG","30","Select","Select",""],["","69097083512","SERTRALINE","100MG","90","Select","Select",""],["","68462010530","ONDANSETRON","4MG","20","Select","Select",""],["","67877056105","METFORMIN","500MG","-30","Select","Select",""],["","53489011905","DOXYCYCL","100MG","-14","Select","Select",""],["","11822334950","ALLERGY","25MG","30","Select","Select",""],["","68462029817","CLOTRIM\/BETA","DIPROP","45","Select","Select",""],["","70436000203","POT CHLORIDE","10MEQ ER","30","Select","Select",""],["","68180016013","AZITHROMYCIN","250MG","6","Select","Select",""],["","50428037624","VITAMIN","1000MCG","90","Select","Select",""]]}},{"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":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[[["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""]]]},{"t":"Mini-Cog","q":[{"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":""}]}]}