{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KATIE MAE DAVIS","gend":1,"add":"4050 VICTORIA BLVD APT 312","city":"HAMPTON","state":"VA","zip":23669,"dob":"1961-03-24","age":"","mstatus":"","insh":"900043587*01","cliId":"","pno":"757\/759-1283","cno":"757\/759-1283    ","email":"","ename":"","eno":"","pphy":"PHYSICIAN, MR PRIMARY CARE MD","ppno":"","pcpadd":"4417 CORPORATION LANE","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23462,"pcpcounty":"","pcpid":"799MR","pcpname":"","plan":"OHP - OPTIMA","program":"MEDICARE","lob":"DSNP","region":"Peninsula","aligned":"Y","ano":"757\/759-1283, ","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["S82.852A","S82.452A","Z47.89","I50.22","K21.9","F20.3","F17.200","S82.852D","M25.572","F17.210","S93.05XA","I50.42","I89.0","F20.9","F32.9","E78.2","Z85.3","Z85.118","Z91.81","S92.355D","S82.62XA","S93.02XA","J45.20","J41.0","Z79.51","Z79.899","Z20.822","Z92.21","Z92.3","Z90.2","S92.355A","E78.5","R07.9","G89.18"],"date":["2021-03-08","2021-02-25","2021-05-12","2021-04-22","2021-04-22","2021-02-27","2021-02-27","2021-05-24","2021-05-12","2021-05-12","2021-02-25","2021-03-30","2021-03-30","2021-03-30","2021-03-30","2021-03-30","2021-04-22","2021-03-30","2021-03-30","2021-04-25","2021-02-25","2021-03-08","2021-02-25","2021-02-25","2021-02-25","2021-02-25","2021-02-25","2021-02-25","2021-02-25","2021-02-25","2021-03-08","2021-03-08","2021-02-25","2021-03-08"],"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":[["","10702001801","OXYCODONE","TAB 5MG","-15","Select","Select",""],["","50428050854","CVS PURELAX","PAK ","60","Select","Select",""],["","536589588","NICOTINE TD","DIS 14MG\/24H","28","Select","Select",""],["","143952901","FLUPHENAZ DE","INJ 25MG\/ML","5","Select","Select",""],["","50428028552","ACETAMINOPHN","TAB 500MG","112","Select","Select",""],["","57664037718","TRAMADOL HCL","TAB 50MG","15","Select","Select",""],["","62175013643","OMEPRAZOLE","CAP 40MG","30","Select","Select",""],["","603243832","BENZTROPINE","TAB 1MG","180","Select","Select",""],["","65162074510","PROMETHAZINE","TAB 12.5MG","30","Select","Select",""],["","527179101","FLUPHENAZINE","TAB 10MG","31","Select","Select",""],["","50428037837","CVS SENNA PL","TAB 8.6-50MG","30","Select","Select",""],["","143952901","FLUPHENAZINE DECANOATE","","5","Select","Select",""],["","50428028552","CVS ACETAMINOPHEN EXTRA STRENGTH","","112","Select","Select",""],["","50428037837","CVS SENNA PLUS","","30","Select","Select",""],["","42858000101","OXYCODONE HYDROCHLORIDE","","-40","Select","Select",""],["","536589588","NICOTINE TRANSDERMAL SYSTEM ","","28","Select","Select",""],["","527179101","FLUPHENAZINE HCL","","31","Select","Select",""],["","65162074510","PROMETHAZINE HCL","","30","Select","Select",""],["","603243832","BENZTROPINE MESYLATE ","","180","Select","Select",""],["","70436006001","BUPROPION HYDROCHLORIDE ER (SR) ","","180","Select","Select",""],["","14539067505","HYDROXYZINE PAMOATE","","180","Select","Select",""],["","69238168101","FLUPHENAZINE HYDROCHLORIDE","","31","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":[[["Select","Select","","","","","Select","",""],["Select","Select","","","","","Select","",""],["Select","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Select","Select","","","","","Select","",""],["No","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":""}]}]}