{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KATHLEEN   A JACKSON","gend":1,"add":"510 JUNIPER CT","city":"SMITHFIELD","state":"VA","zip":"23430-9998","dob":"1955-08-31","age":"","mstatus":"","insh":"900039414*01","cliId":"8ME3HK5UM71","pno":"757\/357-9293","cno":"757\/357-9293","email":"","ename":"","eno":"","pphy":"KNUST, LISA M MD","ppno":"757\/238-7043","pcpadd":"13478 CARROLLTON BOULEVARD STE D &","pcpcity":"CARROLLTON","pcpstate":"VA","pcpzip":23314,"pcpcounty":"","pcpid":118380,"pcpname":"Eagle Harbor Primary Care","plan":"OHP","program":"MEDICARE","lob":"MA-Non DSNP","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/238-7052","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E03.9","M85.89","S62.101A","Z13.820","Z78.0","I10.","I16.0","R11.0","R14.2","R94.31","Z11.59","E11.65","E55.9","Z00.00","D48.5","L90.5","Z12.31","E11.9","E78.2","Z01.419","F51.01","Z23.","L85.3","L82.1","L81.4","D22.9","H16.223","H10.45","H01.02A","H01.02B","H43.813","H25.13","G57.61","M79.671"],"date":["2021-04-28","2021-05-13","2021-05-13","2021-05-13","2021-05-13","2021-04-28","2020-12-29","2020-12-29","2020-12-29","2020-12-29","2020-09-25","2020-09-28","2020-09-28","2021-04-28","2021-04-07","2021-04-20","2021-02-03","2021-04-02","2021-03-30","2021-04-28","2021-04-28","2021-05-12","2021-07-28","2021-07-28","2021-07-28","2021-07-28","2021-08-17","2021-08-17","2021-08-17","2021-08-17","2021-07-27","2021-07-27","2021-09-14","2021-08-31"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","",null,null,null,null,null,null,null,null]}},{"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":[["","068180098201","LISINOPRIL ","30MG","30","Select","Select",""],["","000074518290","SYNTHROID ","75MCG","30","Select","Select",""],["","058160082311","SHINGRIX ","50\/0.5ML","1","Select","Select",""],["","000378180510","LEVOTHYROXIN ","75MCG","-90","Select","Select",""],["","070461012003","FLUAD ","0.5ML","0","Select","Select",""],["","000005197102","PREVNAR ","","0","Select","Select",""],["","050111056003","TRAZODONE ","50MG","90","Select","Select",""],["","000065081604","PATADAY ","0.70%","5","Select","Select",""],["","045802041954","AMMONIUM ","12%","-1125","Select","Select",""],["","061314063705","PREDNISOLONE ","1% OP","10","Select","Select",""],["","00074518290","","75MCG","-30","Select","Select",""],["","00074518290","SYNTHROID","75MCG","-30","Select","Select",""],["","58160082311","SHINGRIX","50\/0.5ML","-1","Select","Select",""],["","70461012003","FLUAD","0.5ML","0","Select","Select",""],["","00005197102","PREVNAR","","0","Select","Select",""],["","68180098201","LISINOPRIL","30MG","30","Select","Select",""],["","00378180510","LEVOTHYROXIN","75MCG","-90","Select","Select",""],["","50111056003","TRAZODONE","50MG","90","Select","Select",""],["","45802041954","AMMONIUM","12%","1125","Select","Select",""],["","61314063710","PREDNISOLONE","1% OP","-100","Select","Select",""],["","00065081604","PATADAY","0.70%","5","Select","Select",""],["","49281012165","FLUZONE","2021-22","1","Select","Select",""],["","49281012165","FLUZONE ","INJ 2021-22","1","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":""}]}]}