{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" WANDA ROWE","gend":1,"add":"405 LANE CRES","city":"SMITHFIELD","state":"VA","zip":"23430-9998","dob":"1971-06-02","age":"","mstatus":"","insh":"1246133*01","cliId":"","pno":"757\/357-5901","cno":"757\/357-5901, 757\/715-2429, ","email":"","ename":"","eno":"","pphy":"POPE, THOMAS C MD","ppno":"757\/357-3331","pcpadd":"201 GUMWOOD DR","pcpcity":"SMITHFIELD","pcpstate":"VA","pcpzip":"23430-9998","pcpcounty":"","pcpid":131791,"pcpname":"","plan":"OHP - OPTIMA","program":"ACA","lob":"Individual","region":"TIDEWATER","aligned":"","ano":"","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":["F33.2","Z12.31","Z98.82","E78.2","R73.01","Z72.0","F33.9","J30.89","K21.9","Z86.69","L57.8","L85.3","L81.4","L57.0","D22.5","D22.61","D22.62","D48.5","D22.71","D22.72","L50.0","T41.3X5D","R21.","M54.5","Z00.00","Z98.51","Z90.710","R31.29","F51.01","C44.519"],"date":["2020-04-22","2020-02-17","2020-02-17","2021-05-11","2021-05-11","2021-05-11","2021-05-11","2021-05-11","2021-05-11","2021-05-11","2020-03-05","2020-03-05","2020-03-05","2020-03-05","2020-03-05","2020-03-05","2020-03-05","2020-03-05","2020-03-05","2020-03-05","2020-03-25","2020-03-25","2020-04-16","2020-06-25","2020-12-29","2020-12-29","2020-12-29","2020-12-29","2020-12-29","2020-07-16"],"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":[["","65862055990","PANTOPRAZOLE","20MG","-60","Select","Select",""],["","43598016630","OLANZAPINE","10MG","30","Select","Select",""],["","70377002811","ATORVASTATIN","20MG","30","Select","Select",""],["","13668000801","ZOLPIDEM","10MG","30","Select","Select",""],["","00046110281","PREMARIN","0.625MG","-30","Select","Select",""],["","51991070605","ALPRAZOLAM","1MG","90","Select","Select",""],["","57664049983","MIRTAZAPINE","15MG","60","Select","Select",""],["","00591264001","BUT\/APAP\/CAF","","20","Select","Select",""],["","00555088602","ESTRADIOL","1MG","30","Select","Select",""],["","61570007301","MENEST","0.625MG","90","Select","Select",""],["","00406012301","HYDROCO\/APAP","5-325MG","18","Select","Select",""],["","13668013710","ESCITALOPRAM","20MG","30","Select","Select",""],["","00527293341","PREDNISONE","10MG","21","Select","Select",""],["","57237007710","ONDANSETRON","4MG ODT","12","Select","Select",""],["","00143980350","DOXYCYCL","100MG","20","Select","Select",""],["","55111018015","TIZANIDINE","4MG","20","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":""}]}]}