{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TRISHIA   C CURRY","gend":1,"add":"848 MAITLAND DR","city":"VIRGINIA BEACH","state":"VA","zip":"23454-9998","dob":"1975-06-25","age":"","mstatus":"","insh":"1089793*01","cliId":"","pno":"757\/426-6180","cno":"757\/426-6180","email":"","ename":"","eno":"","pphy":"BAKHSHI, ELIZABETH MD","ppno":"757\/481-3770","pcpadd":"1821 OLD DONATION PKWY SUITE #4","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23454,"pcpcounty":"","pcpid":120796,"pcpname":"","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"757\/714-4870","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":["K22.8","H16.223","Z86.010","K62.5","D12.8","D12.3","K64.1","Z01.419","Z12.39","Z80.41","Z84.89","A60.00","N90.89","J02.9","Z12.31","N64.89","L72.3","K21.0","Z87.19","Z90.49","Z87.891","Z88.6","Z88.1","Z91.048","Z79.899","Z90.79","K22.10","K29.50","K63.5","K62.1","K21.9","Z88.5","Z88.8","Z98.1","K22.70","K20.0","N89.8","N39.3","K62.89","R92.8","N76.0","B96.89","H90.41","H93.13","H66.92","D32.9","H93.11","H81.399","Z12.4","Z78.0","Z80.0","D32.0"],"date":["2020-01-09","2020-06-15","2020-02-13","2020-02-13","2020-02-13","2020-02-13","2020-02-13","2021-09-22","2020-07-21","2021-10-07","2020-07-21","2020-07-21","2020-09-30","2020-12-15","2021-07-30","2020-07-30","2020-09-30","2020-01-09","2020-01-09","2020-02-13","2020-02-13","2020-01-09","2020-02-13","2020-02-13","2020-02-13","2020-01-09","2020-01-09","2020-01-09","2020-02-13","2020-02-13","2020-02-13","2020-02-13","2020-02-13","2020-02-13","2021-06-14","2020-01-09","2021-02-17","2021-02-17","2020-02-13","2020-07-30","2021-02-17","2021-02-17","2021-06-17","2021-06-17","2021-06-29","2021-09-25","2021-08-11","2021-08-11","2021-09-22","2021-09-22","2021-10-07","2021-09-25"],"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":[["","00143962125","CYANOCOBALAM","1000MCG","1","Select","Select",""],["","08290329622","INSULIN","1ML\/25G","3","Select","Select",""],["","31722070430","VALACYCLOVIR","500MG","90","Select","Select",""],["","65862056090","PANTOPRAZOLE","40MG","90","Select","Select",""],["","00093317431","ALBUTEROL","HFA","8","Select","Select",""],["","65862018601","CLINDAMYCIN","300MG","28","Select","Select",""],["","00781808926","AZITHROMYCIN","250MG","6","Select","Select",""],["","57237000511","FLUCONAZOLE","150MG","2","Select","Select",""],["","49281042050","FLUZONE","2020-21","0","Select","Select",""],["","00173068220","VENTOLIN","","18","Select","Select",""],["","59762371809","TRIAZOLAM","0.25MG","2","Select","Select",""],["","00781707787","METRONIDAZOL","0.75%VAG","70","Select","Select",""],["","59267100001","PFIZER","COVID-19","0","Select","Select",""],["","08290329622","INSULIN ","1ML\/25G","3","Select","Select",""],["","00143962125","CYANOCOBALAM ","1000MCG","1","Select","Select",""],["","31722070430","VALACYCLOVIR ","500MG","90","Select","Select",""],["","65862056090","PANTOPRAZOLE ","40MG","90","Select","Select",""],["","00173068220","VENTOLIN ","","18","Select","Select",""],["","00093317431","ALBUTEROL ","HFA","8","Select","Select",""],["","59762371809","TRIAZOLAM ","0.25MG","2","Select","Select",""],["","65862018601","CLINDAMYCIN ","300MG","28","Select","Select",""],["","49281042050","FLUZONE ","2020-21","0","Select","Select",""],["","00781808926","AZITHROMYCIN ","250MG","6","Select","Select",""],["","57237000511","FLUCONAZOLE ","150MG","-2","Select","Select",""],["","00781707787","METRONIDAZOL ","0.75%VAG","70","Select","Select",""],["","59267100001","PFIZER ","COVID-19","0","Select","Select",""],["","58160088752","FLUARIX ","INJ 2021-22","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":""}]}]}