{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"REBECCA DEWOODY","gend":1,"add":"500 BOTETOURT ST APT 705","city":"NORFOLK","state":"VA","zip":"23510-9998","dob":"1980-06-12","age":"","mstatus":"","insh":"1193215*01","cliId":"","pno":"757\/589-7263","cno":"757\/589-7263","email":"","ename":"","eno":"","pphy":"TAN-GONZALES, DESIREE MD","ppno":"757\/548-0076","pcpadd":"725 VOLVO PKWY SUITE 100","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":23320,"pcpcounty":"","pcpid":129852,"pcpname":"Volvo Medical Associates","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/548-1652","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E66.01","Z68.43","H40.009","E28.2","E55.9","F32.9","R73.03","E03.8","E06.3","F41.1","Z87.898","L71.9","L82.1","L72.11","D22.9","Z01.419","Z12.39","N90.7","Z11.59","Z03.818","D49.2","M79.2","M79.672","G43.709","R94.31","J01.90","M19.072","M77.32","Z20.828","K59.09","R63.2","G47.00","Z68.44","F41.0","E03.9","Z12.31","R22.42","E78.2","R10.2","R52.","R14.0","N83.12","Z13.1","Z13.220","Z13.29","Z13.21"],"date":["2021-08-11","2021-03-26","2020-12-22","2020-12-22","2020-12-22","2021-03-26","2021-03-26","2021-03-26","2021-03-26","2021-04-01","2020-12-22","2021-01-15","2021-01-15","2021-01-15","2021-01-15","2021-02-22","2021-02-22","2020-03-13","2020-08-18","2020-08-18","2021-05-24","2021-07-23","2021-05-21","2021-11-10","2020-09-30","2021-08-23","2021-05-21","2021-05-21","2020-12-23","2021-02-08","2021-03-26","2021-09-14","2020-06-29","2021-09-14","2021-09-14","2021-04-14","2021-05-24","2020-05-28","2021-08-11","2021-08-10","2021-08-10","2021-08-11","2021-09-14","2021-09-14","2021-09-14","2021-09-14"],"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":[["","69238183801","LEVOTHYROXIN","150MCG","90","Select","Select",""],["","65862052890","VENLAFAXINE","75MG ER","30","Select","Select",""],["","23155010205","METFORMIN","500MG","180","Select","Select",""],["","00228278111","PROPRANOLOL","160MG ER","-5","Select","Select",""],["","00074707090","SYNTHROID","175MCG","90","Select","Select",""],["","51862094105","DIAZEPAM","2MG","14","Select","Select",""],["","00093553901","ESZOPICLONE","3MG","30","Select","Select",""],["","00169413602","OZEMPIC","2\/1.5ML","3","Select","Select",""],["","66685100100","AMOX\/K","875-125","14","Select","Select",""],["","69315090401","LORAZEPAM","0.5MG","30","Select","Select",""],["","60505083001","MOMETASONE","50MCG","17","Select","Select",""],["","00406012305","HYDROCO\/APAP","5-325MG","16","Select","Select",""],["","00527217037","DICLOFENAC","100MG ER","30","Select","Select",""],["","58160088552","FLUARIX","2020-21","0","Select","Select",""],["","64380080807","IBUPROFEN","600MG","30","Select","Select",""],["","65862018601","CLINDAMYCIN","300MG","22","Select","Select",""],["","60505083305","AZELASTINE","0.10%","30","Select","Select",""],["","69238183801","LEVOTHYROXIN ","150MCG","90","Select","Select",""],["","65862052890","VENLAFAXINE ","75MG ER","30","Select","Select",""],["","50228010501","METFORMIN ","500MG","180","Select","Select",""],["","00228278111","PROPRANOLOL ","160MG ER","5","Select","Select",""],["","00093553901","ESZOPICLONE ","3MG","30","Select","Select",""],["","00074707090","SYNTHROID ","175MCG","-90","Select","Select",""],["","00169413212","OZEMPIC ","2\/1.5ML","-2","Select","Select",""],["","51862094105","DIAZEPAM ","2MG","14","Select","Select",""],["","00406012305","HYDROCO\/APAP ","5-325MG","16","Select","Select",""],["","64380080807","IBUPROFEN ","600MG","30","Select","Select",""],["","65862018601","CLINDAMYCIN ","300MG","22","Select","Select",""],["","58160088552","FLUARIX ","2020-21","0","Select","Select",""],["","66685100100","AMOX\/K ","875-125","14","Select","Select",""],["","60505083305","AZELASTINE ","0.10%","30","Select","Select",""],["","69315090405","LORAZEPAM ","0.5MG","30","Select","Select",""],["","60505083001","MOMETASONE ","50MCG","-17","Select","Select",""],["","00527217037","DICLOFENAC ","100MG ER","30","Select","Select",""],["","42806040021","METHYLPRED ","4MG","21","Select","Select",""],["","42806040021","METHYLPRED","4MG","21","Select","Select",""],["","49281072110","FLUBLOK ","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":""}]}]}