{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JESSICA   C FREEMAN","gend":1,"add":"2047 ALLISON DR","city":"CHESAPEAKE","state":"VA","zip":"23325-9998","dob":"1979-12-14","age":"","mstatus":"","insh":"900045670*01","cliId":"6RA2DP6AM80","pno":"757\/689-7009","cno":"757\/689-7009","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","program":"MEDICARE","lob":"DSNP","region":"TIDEWATER","aligned":"Y","ano":"Non-DSNP","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":["R35.0","R39.9","R73.03","D50.9","E78.2","K21.9","K58.2","Z00.00","J31.0","R40.0","H91.93","G43.009","E66.01","R11.0","Z01.419","D25.9","N96.","R10.32","G47.30","J30.1","J32.9","J34.2","J34.3","Z11.3","B34.9","R51.9","M54.5","R05.","R53.1","H91.90","K50.90","N28.1","K76.0","K57.90","Z20.822","K58.9","Z79.899","N85.2","R10.9","R19.7","R07.89","R53.83","Z12.31","N93.8","R05.9","R06.02","R91.8","J02.9","N39.0","N93.9","Z87.59"],"date":["2021-04-05","2021-02-13","2021-05-20","2021-05-20","2021-05-20","2021-10-28","2021-05-20","2021-05-20","2021-05-20","2021-05-20","2021-07-21","2021-05-20","2021-09-24","2021-05-20","2021-07-21","2021-09-24","2021-09-15","2021-07-24","2021-08-10","2021-08-10","2021-08-10","2021-08-10","2021-08-10","2021-07-21","2021-10-28","2021-10-28","2021-07-24","2021-07-24","2021-07-24","2021-10-28","2021-10-28","2021-07-24","2021-07-24","2021-07-24","2021-10-28","2021-10-28","2021-10-28","2021-07-24","2021-07-24","2021-07-24","2021-07-24","2021-07-24","2021-06-23","2021-09-15","2021-10-28","2021-10-28","2021-10-28","2021-10-28","2021-07-21","2021-09-24","2021-09-24"],"priorHcc":["","","","","",null,"","","","","","",null,"","",null,null,"","","","","","","",null,null,"","","",null,null,"","","",null,null,null,"","","","","","",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":[["","245010801","FERROUS SULF","TAB 325MG EC","180","Select","Select",""],["","16714089902","FEXOFENADINE","TAB 180MG","30","Select","Select",""],["","16714074703","OMEPRAZOLE","CAP 20MG","90","Select","Select",""],["","51660093901","CETIRIZINE","TAB 10MG","30","Select","Select",""],["","65162047810","NITROFURANTN","CAP 100MG","14","Select","Select",""],["","60432026415","FLUTICASONE","SPR 50MCG","48","Select","Select",""],["","904759080","FEROSUL","TAB 325MG","180","Select","Select",""],["","245010801","FERROUS SULFATE ","","180","Select","Select",""],["","16714089902","FEXOFENADINE HYDROCHLORIDE","","30","Select","Select",""],["","60432026415","FLUTICASONE PROPIONATE","","48","Select","Select",""],["","51660093901","CETIRIZINE HYDROCHLORIDE","","30","Select","Select",""],["","65162047810","NITROFURANTOIN MONOHYDRATE\/MACROCRYSTALS","","14","Select","Select",""],["","904759080","FEROSUL ","","180","Select","Select",""],["","55111015330","ONDANSETRON HYDROCHLORIDE ","","-30","Select","Select",""],["","00245010801","FERROUS SULFATE","","180","Select","Select",""],["","55111015330","ONDANSETRON HYDROCHLORIDE","","30","Select","Select",""],["","65862039010","ONDANSETRON ODT","4MG ODT","-15","Select","Select",""],["","64380071206","BENZONATATE","100MG","21","Select","Select",""],["","00245010801","FERROUS SULFATE                                                       ","TAB 325MG EC","180","Select","Select",""],["","00781286810","OMEPRAZOLE                                                            ","CAP 20MG","90","Select","Select",""],["","65162047810","NITROFURANTOIN MONOHYDRATE\/MACROCRYSTALS                              ","CAP 100MG","14","Select","Select",""],["","16714089902","FEXOFENADINE HYDROCHLORIDE                                            ","TAB 180MG","30","Select","Select",""],["","51660093901","CETIRIZINE HYDROCHLORIDE                                              ","TAB 10MG","30","Select","Select",""],["","60432026415","FLUTICASONE PROPIONATE                                                ","SPR 50MCG","48","Select","Select",""],["","00904759080","FEROSUL                                                               ","TAB 325MG","180","Select","Select",""],["","55111015330","ONDANSETRON HYDROCHLORIDE                                             ","TAB 4MG","-30","Select","Select",""],["","64380071206","BENZONATATE                                                           ","CAP 100MG","21","Select","Select",""],["","65862039010","ONDANSETRON ODT                                                       ","TAB 4MG ODT","15","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":[[["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","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":""}]}]}