{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"IRIS MILLER","gend":1,"add":"PO BOX 2459","city":"CHESAPEAKE","state":"VA","zip":"23327-9998","dob":"1978-04-14","age":"","mstatus":"","insh":"1089257*01","cliId":"","pno":"757\/309-1329","cno":"757\/309-1329","email":"","ename":"","eno":"","pphy":"RAMSEY, KRISTIN DO","ppno":"757\/488-3333","pcpadd":"3925 PORTSMOUTH BLVD","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":23321,"pcpcounty":"","pcpid":137859,"pcpname":"Princess Anne Family Medicine","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"757\/309-1329","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/488-0007","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E66.9","D64.9","R73.09","E78.6","M54.5","E78.5","J45.909","R79.0","N92.6","R60.9","I10.","Z11.3","N92.5","Z12.4","M25.561","R22.41"],"date":["2020-06-05","2020-07-09","2021-08-10","2020-02-25","2021-08-10","2021-08-10","2021-08-10","2020-10-27","2020-12-22","2021-03-27","2021-09-15","2021-08-13","2021-08-20","2021-08-13","2021-09-15","2021-09-15"],"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":[["","65162019050","NAPROXEN","500MG","-60","Select","Select",""],["","10702002501","PHENTERMINE","37.5MG","45","Select","Select",""],["","50111033401","METRONIDAZOL","500MG","14","Select","Select",""],["","69097015907","MELOXICAM","15MG","-30","Select","Select",""],["","00378020810","FUROSEMIDE","20MG","180","Select","Select",""],["","00031875712","ROBIT","20-200","118","Select","Select",""],["","69452015120","VITAMIN","50000UNT","12","Select","Select",""],["","00093310905","AMOXICILLIN","500MG","21","Select","Select",""],["","67877032105","IBUPROFEN","800MG","-90","Select","Select",""],["","60505265601","TRIAMT\/HCTZ","37.5-25","-30","Select","Select",""],["","00536100901","FERROUS","325MG","90","Select","Select",""],["","60505025203","TIZANIDINE","4MG","30","Select","Select",""],["","00245531911","KLOR-CON","20MEQ ER","180","Select","Select",""],["","53746010901","HYDROCO\/APAP","5-325MG","10","Select","Select",""],["","59779043326","","","118","Select","Select",""],["","59310057922","PROAIR","","-8","Select","Select",""],["","00093317431","ALBUTEROL","HFA","8","Select","Select",""],["","70710113908","FLUCONAZOLE","150MG","1","Select","Select",""],["","00173068220","VENTOLIN","","18","Select","Select",""],["","65162019050","NAPROXEN ","500MG","60","Select","Select",""],["","67877032105","IBUPROFEN ","800MG","-90","Select","Select",""],["","10702002501","PHENTERMINE ","37.5MG","45","Select","Select",""],["","60505025203","TIZANIDINE ","4MG","60","Select","Select",""],["","69097015907","MELOXICAM ","15MG","30","Select","Select",""],["","50111033401","METRONIDAZOL ","500MG","14","Select","Select",""],["","00378020810","FUROSEMIDE ","20MG","180","Select","Select",""],["","53746010901","HYDROCO\/APAP ","5-325MG","10","Select","Select",""],["","00093310905","AMOXICILLIN ","500MG","21","Select","Select",""],["","60505265601","TRIAMT\/HCTZ ","37.5-25","30","Select","Select",""],["","00031875712","ROBIT ","20-200","118","Select","Select",""],["","00904052380","VITAMIN ","500MG","30","Select","Select",""],["","00536100901","FERROUS ","325MG","90","Select","Select",""],["","59310057922","PROAIR ","","-8","Select","Select",""],["","00093317431","ALBUTEROL ","HFA","8","Select","Select",""],["","00173068220","VENTOLIN ","","18","Select","Select",""],["","70710113908","FLUCONAZOLE ","150MG","1","Select","Select",""],["","00245531911","KLOR-CON ","20MEQ ER","180","Select","Select",""],["","80777027398","MODERNA","COVID-19","0","Select","Select",""],["","59267100002","PFIZER","COVID-19","0","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":""}]}]}