{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TAMMY   S MITCHELL","gend":1,"add":"313 LEES MILL DR","city":"NEWPORT NEWS","state":"VA","zip":"23608-9998","dob":"1967-07-28","age":"","mstatus":"","insh":"900041023*01","cliId":"7FN9AN1NP39","pno":"757\/817-3378","cno":"757\/817-3378","email":"","ename":"","eno":"","pphy":"ARNOLD, HELEN G DO","ppno":"757\/930-0091","pcpadd":"12715 WARWICK BLVD STE O","pcpcity":"NEWPORT NEWS","pcpstate":"VA","pcpzip":23606,"pcpcounty":"","pcpid":118380,"pcpname":"Commonwealth Family Practice","plan":"OHP","program":"MEDICARE","lob":"MA-NON DSNP","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/269-4406","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R25.2","I10.","E78.00","E11.9","Z79.84","E55.9","E66.9","Z68.38","R29.898","R20.2","M62.838","M51.16","M51.36","Z68.39","S90.424A","D50.8","M51.26","M51.27","M47.817","M47.816","M51.14","M99.72","S80.869A","L29.9","M25.561","M25.562","G89.29","E11.8","F25.9","F25.0","F51.01","F31.81","Z00.00","H53.9","L70.0","S80.12XA","Z09.","Z91.81","Z12.11"],"date":["2021-03-15","2021-06-07","2021-03-15","2021-05-04","2021-03-15","2021-03-15","2021-06-07","2021-03-15","2021-06-07","2021-05-13","2021-06-07","2021-06-07","2021-06-07","2021-06-07","2021-06-07","2021-04-19","2021-06-07","2021-06-07","2021-06-07","2021-06-07","2021-06-07","2021-06-07","2021-06-21","2021-06-21","2021-06-21","2021-06-21","2021-06-21","2021-01-07","2021-01-07","2021-02-08","2021-02-23","2021-02-23","2021-05-04","2021-05-04","2021-05-04","2021-05-04","2021-05-17","2021-05-17","2021-05-23"],"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":[["","068180072103","AMLODIPINE ","10MG","90","Select","Select",""],["","055111018015","TIZANIDINE ","4MG","-180","Select","Select",""],["","068180098103","LISINOPRIL ","20MG","90","Select","Select",""],["","029300012510","MELOXICAM ","15MG","90","Select","Select",""],["","067877024901","QUETIAPINE ","50MG","-30","Select","Select",""],["","065862016001","ZOLPIDEM ","10MG","-30","Select","Select",""],["","000781107905","ALPRAZOLAM ","1MG","30","Select","Select",""],["","065862020199","LOSARTAN ","25MG","30","Select","Select",""],["","075834002012","VITAMIN ","50000UNT","13","Select","Select",""],["","064980033912","MAGNESIUM-OX ","400MG","60","Select","Select",""],["","031604002576","MAGNESIUM ","400MG","60","Select","Select",""],["","000054429731","FUROSEMIDE ","20MG","30","Select","Select",""],["","050742061601","METOPROL ","50MG ER","30","Select","Select",""],["","065162010250","GABAPENTIN ","300MG","30","Select","Select",""],["","045963067611","METOPROLOL ","50MG ER","30","Select","Select",""],["","000904759080","FEROSUL ","325MG","90","Select","Select",""],["","051672530703","DAPSONE ","7.50%","60","Select","Select",""],["","000406012305","HYDROCO\/APAP ","5-325MG","-18","Select","Select",""],["","000093101042","MUPIROCIN ","2%","22","Select","Select",""],["","000591352530","LIDOCAINE ","5%","30","Select","Select",""],["","051672128202","TRIAMCINOLON ","0.10%","-30","Select","Select",""],["","064380080707","IBUPROFEN ","800MG","60","Select","Select",""],["","023155050105","HYDROXYZ ","25MG","30","Select","Select",""],["","065862001705","AMOXICILLIN ","500MG","-20","Select","Select",""],["","68180098103","","20MG","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":""}]}]}