{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"COURTNEY   W KELLY","gend":1,"add":"2232 WINDWARD SHORE DR","city":"VIRGINIA BEACH","state":"VA","zip":"23451-9998","dob":"1987-11-24","age":"","mstatus":"","insh":"1139534*02","cliId":"","pno":"757\/377-4080","cno":"757\/377-4080","email":"","ename":"","eno":"","pphy":"MCDERMOTT, GLENN MD","ppno":"757\/412-0006","pcpadd":"1368 N GREAT NECK RD","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23454,"pcpcounty":"","pcpid":165136,"pcpname":"","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"757\/377-4080","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/496-2069","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z01.419","Z11.51","N92.6","L57.8","D22.5","L81.2","D48.5","I87.2","R94.6","E03.9","Z79.899","H01.001","H00.12","Z34.90","Z34.91","I83.891","I87.391","I87.302","K90.0","Z3A.11","O99.281","L65.9","E28.2","O99.282","Z20.828","Z30.09","O36.80X9","Z00.00","D22.9","O22.22","I82.811","Z3A.18","Z88.1","Z91.018","R22.41","Z34.82","Z3A.19","Z36.3","Z3A.21","R79.89","M79.604","O99.283","Z3A.25","Z36.9","Z23.","Z3A.31","M79.605","Z36.85","L82.1","D18.01","O26.843","Z3A.38","Z34.93","Z3A.39","Z3A.35","Z86.16"],"date":["2020-01-31","2020-01-31","2020-01-31","2020-05-28","2021-10-05","2021-10-05","2020-05-28","2021-10-20","2020-02-12","2021-10-20","2021-07-12","2020-09-29","2020-09-29","2021-03-29","2021-04-27","2020-01-09","2020-01-09","2020-01-09","2021-10-20","2021-05-05","2021-05-05","2020-12-10","2020-12-10","2021-07-12","2020-08-26","2020-01-31","2021-04-14","2020-03-06","2020-03-06","2021-06-21","2021-06-21","2021-06-21","2021-06-21","2021-06-21","2021-06-21","2021-06-30","2021-06-30","2021-06-30","2021-07-12","2021-10-20","2021-06-21","2021-10-20","2021-08-12","2021-08-26","2021-11-16","2021-09-20","2021-10-20","2021-10-28","2021-10-05","2021-10-05","2021-11-09","2021-11-09","2021-11-16","2021-11-16","2021-10-20","2021-10-20"],"priorHcc":["","","","",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":[["","60846081101","UNITHROID","200MCG","-90","Select","Select",""],["","24208091055","ERYTHROMYCIN","OP","4","Select","Select",""],["","00378181977","LEVOTHYROXIN","200MCG","90","Select","Select",""],["","60846081101","UNITHROID ","200MCG","90","Select","Select",""],["","00378181977","LEVOTHYROXIN ","200MCG","90","Select","Select",""],["","24208091055","ERYTHROMYCIN ","OP","4","Select","Select",""],["","59267100003","PFIZER ","COVID-19","0","Select","Select",""],["","59267100003","PFIZER","COVID-19","0","Select","Select",""],["","43547040011","CYCLOBENZAPR","10MG","21","Select","Select",""],["","43547040011","CYCLOBENZAPR ","TAB 10MG","21","Select","Select",""],["","65162046550","IBUPROFEN ","TAB 600MG","60","Select","Select",""],["","00781324664","ENOXAPARIN ","INJ 40\/0.4ML","4","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":""}]}]}