{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KIMBERLY PUCKETT","gend":1,"add":"1536 PLANTATION LAKES CIR","city":"CHESAPEAKE","state":"VA","zip":"23320-9998","dob":"1976-12-14","age":"","mstatus":"","insh":"1071842*01","cliId":"","pno":"757\/803-1870","cno":"757\/803-1870","email":"","ename":"","eno":"","pphy":"WINTERS, MARK MD","ppno":"757\/499-5550","pcpadd":"351 EDWIN DR #102","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23462,"pcpcounty":"","pcpid":126202,"pcpname":"HOLLAND ROAD FAMILY MEDICINE","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/473-0919","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F33.2","F41.1","F43.23","F34.1","F10.10","F17.210","F60.9","B34.9","F90.9","R30.0","R10.32","N92.4","R00.0","R10.2","R00.2","R07.89","M79.18","R45.0","R07.9"],"date":["2020-07-17","2021-01-08","2020-05-21","2020-05-21","2020-05-21","2020-05-21","2020-04-30","2020-03-19","2020-05-21","2020-05-26","2020-05-26","2021-01-08","2021-01-08","2021-01-08","2021-01-08","2021-09-02","2021-09-02","2021-09-02","2021-09-02"],"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":[["","68645056354","IBUPROFEN","800MG","30","Select","Select",""],["","74312035873","D3","250MCG","4","Select","Select",""],["","43547028111","ESCITALOPRAM","10MG","-30","Select","Select",""],["","65862007701","CIPROFLOXACN","500MG","20","Select","Select",""],["","42806016005","HYDROXYZ","25MG","20","Select","Select",""],["","50111033402","METRONIDAZOL","500MG","21","Select","Select",""],["","65162019050","NAPROXEN","500MG","20","Select","Select",""],["","74312035873","D3 ","250MCG","4","Select","Select",""],["","68645056354","IBUPROFEN ","800MG","30","Select","Select",""],["","43547028111","ESCITALOPRAM ","10MG","30","Select","Select",""],["","50111033402","METRONIDAZOL ","500MG","21","Select","Select",""],["","65862007701","CIPROFLOXACN ","500MG","20","Select","Select",""],["","42806016005","HYDROXYZ ","25MG","20","Select","Select",""],["","65162019050","NAPROXEN ","500MG","20","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","",""],["N\/A","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","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":""}]}]}