{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JENNY   L ROBINSON","gend":1,"add":"539 ROGERS AVE","city":"HAMPTON","state":"VA","zip":"23664-9998","dob":"1967-04-10","pno":"757\/291-7429","cno":"757\/291-7429","email":"","pphy":"ARNOLD, HELEN G DO","ppno":"","pcpadd":"12715 WARWICK BLVD STE O","pcpcity":"NEWPORT NEWS","pcpstate":"VA","pcpzip":23606,"pcpcounty":"","pcpid":118380,"pcpname":"Commonwealth Family Practice","insh":"1202565*01","cliId":"","plan":"OHP","program":"ACA","lob":"Individual","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/269-4406","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E78.5","F17.210","I10.","I25.10","I82.90","K75.81","N63.10","Z12.11","R31.29","Z00.00","E55.9","R73.03","K76.0","R10.2","Z12.31","H25.812","H25.811","Z23.","K21.9","I82.890","Z20.828","N64.4","F41.9","R19.7","Z83.71","N63.0","L81.4","L82.1","D22.9","L21.9","Z85.828","L57.8","D18.01","L57.0","L82.0","D48.5","J06.9","R00.2","Z01.419","H43.813","H25.042","H04.123","H01.02A","H01.02B","R94.39","R94.31","M62.471","M62.472","M72.2","B07.0","M79.672","M79.671","S90.851A","R10.9","R10.30","I49.49","I47.1","I44.7","I49.9","J20.9","T14.8XXA","Z01.818","H26.9","R07.9","Z01.810"],"date":["2021-09-22","2021-09-22","2021-07-14","2021-09-22","2021-09-22","2020-09-23","2020-07-02","2020-12-11","2021-04-05","2021-07-14","2021-07-14","2021-07-14","2021-07-14","2021-07-28","2020-06-30","2021-06-29","2021-06-29","2020-09-14","2021-07-14","2021-07-14","2021-01-23","2021-07-30","2021-04-05","2020-02-19","2020-12-11","2020-07-02","2020-07-16","2021-07-22","2021-07-22","2021-07-22","2021-07-22","2021-07-22","2021-07-22","2021-07-22","2021-07-22","2021-07-22","2020-03-11","2021-08-12","2021-06-24","2021-04-08","2021-04-08","2021-04-08","2021-04-08","2021-04-08","2021-09-21","2021-09-21","2020-08-11","2020-08-11","2020-08-11","2020-08-11","2020-08-11","2020-08-11","2020-08-11","2020-11-20","2021-07-30","2021-08-09","2021-08-09","2021-08-12","2021-08-09","2020-02-23","2020-08-03","2021-07-14","2021-07-14","2021-08-12","2021-08-12"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",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":[["","50458057930","XARELTO","20MG","30","Select","Select",""],["","31722070090","LOSARTAN","25MG","30","Select","Select",""],["","67877057305","BENZONATATE","100MG","15","Select","Select",""],["","54879000460","BETAMETH","0.10%","60","Select","Select",""],["","00781286810","OMEPRAZOLE","20MG DR","90","Select","Select",""],["","45802046564","KETOCONAZOLE","2%","120","Select","Select",""],["","00472011720","TRETINOIN","0.03%","20","Select","Select",""],["","80777027399","MODERNA","COVID-19","0","Select","Select",""],["","67877059101","METOPROL","50MG ER","30","Select","Select",""],["","51672411806","FLUOROURACIL","5%","40","Select","Select",""],["","50458057930","XARELTO ","TAB 20MG","-30","Select","Select",""],["","67877057305","BENZONATATE ","CAP 100MG","15","Select","Select",""],["","31722070090","LOSARTAN ","TAB 25MG","30","Select","Select",""],["","54879000460","BETAMETH ","LOT 0.001","60","Select","Select",""],["","00781286810","OMEPRAZOLE ","CAP 20MG DR","30","Select","Select",""],["","00472011720","TRETINOIN ","CRE 0.00025","20","Select","Select",""],["","45802046564","KETOCONAZOLE ","SHA 0.02","120","Select","Select",""],["","80777027399","MODERNA ","INJ COVID-19","0","Select","Select",""],["","50742061601","METOPROL ","TAB 50MG ER","30","Select","Select",""],["","51672411806","FLUOROURACIL ","CRE 0.05","40","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","",""],["Yes","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":""}]}]}