{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" PATRICIA GARCEZ","gend":1,"add":"2225 WOLF ST","city":"VIRGINIA BEACH","state":"VA","zip":"23454-9998","dob":"1964-08-29","age":"","mstatus":"","insh":"1247809*01","cliId":"","pno":"757\/779-1974","cno":"757\/779-1974, ","email":"","ename":"","eno":"","pphy":"BOULANGER, PHILIP MD","ppno":"757\/222-0300","pcpadd":"2901 SOUTH LYNNHAVEN ROAD SUITE 450","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":"23452-9998","pcpcounty":"","pcpid":190887,"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":["J90.","T85.9XXA","C34.31","C34.91","Z98.890","C34.01","J40.","R51.","Z85.118","M48.02","M50.322","M50.321","M50.31","M47.812","M47.811","M54.2","R91.8","C34.11","J93.9","J43.9","J94.8","J44.9","Z87.01","Z79.899","Z82.0","Z80.1","Z80.0","Z87.891","Z90.2","Z96.89","Z46.82","Z51.11","C34.90","K76.89","M50.30","M43.12","C44.212","C44.629","D48.5","R91.1","R53.1","Z01.812","Z20.822","T17.590A","J98.19","Z48.03","K52.1","Z00.00","Z23.","Z12.31","J44.1","R06.09","Z48.3","Z79.2","J18.9","J98.11","Z92.21","Z53.32","J93.12","F32.0","R10.30","J98.4","R51.9","M25.78","C44.319","Z71.9","R59.0","F17.218","J98.8","L57.0","L82.1","L81.4","D18.00","L57.8","D22.9","Z85.828","L90.5","Z12.83","Z12.11","J06.9","Z01.810","J98.09"],"date":["2021-02-28","2020-01-08","2021-06-04","2021-03-29","2021-03-29","2021-06-04","2020-09-23","2020-09-23","2021-01-29","2021-03-04","2020-10-27","2020-10-27","2020-10-27","2021-03-04","2020-10-27","2020-12-17","2021-02-27","2021-03-10","2021-03-09","2021-05-28","2021-05-28","2021-03-09","2021-03-09","2021-03-09","2021-03-09","2021-03-09","2021-03-09","2021-03-09","2021-05-28","2021-03-09","2021-03-01","2020-04-15","2021-03-01","2020-05-28","2020-11-20","2020-11-20","2020-11-23","2020-12-15","2020-12-15","2021-01-28","2021-03-01","2021-02-19","2021-02-19","2021-02-24","2021-02-24","2021-03-04","2020-05-01","2020-11-23","2020-11-23","2020-11-23","2020-11-23","2021-01-26","2021-03-04","2021-03-04","2021-02-22","2021-02-25","2021-02-22","2021-02-22","2020-01-02","2020-05-01","2020-05-06","2021-02-22","2020-10-27","2020-10-27","2020-12-15","2020-12-15","2021-02-22","2021-02-22","2021-02-22","2020-11-23","2020-11-23","2020-11-23","2020-11-23","2020-11-23","2020-11-23","2020-11-23","2020-11-23","2020-11-23","2020-08-31","2020-10-23","2021-02-19","2021-05-28"],"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":[["","00406012301","HYDROCO\/APAP","5-325MG","42","Select","Select",""],["","00173086910","ANORO","62.5-25","-60","Select","Select",""],["","57237007810","ONDANSETRON","8MG ODT","30","Select","Select",""],["","67877022310","GABAPENTIN","300MG","90","Select","Select",""],["","00781286810","OMEPRAZOLE","20MG DR","30","Select","Select",""],["","00054418425","DEXAMETHASON","4MG","6","Select","Select",""],["","59746011506","PROCHLORPER","10MG","30","Select","Select",""],["","55111016330","OLANZAPINE","2.5MG","16","Select","Select",""],["","54629012800","FOLIC","1000MCG","30","Select","Select",""],["","88888888887","DMR","","1","Select","Select",""],["","50111078751","AZITHROMYCIN","250MG","6","Select","Select",""],["","00527143501","METAXALONE","800MG","90","Select","Select",""],["","00904645780","DOK","100MG","60","Select","Select",""],["","50228046601","NABUMETONE","750MG","60","Select","Select",""],["","42806071401","BENZONATATE","100MG","30","Select","Select",""],["","00173068220","VENTOLIN","","18","Select","Select",""],["","00597015561","STIOLTO","2.5-2.5","4","Select","Select",""],["","51862036240","FLUOROURACIL","5%","40","Select","Select",""],["","51862054201","BUT\/APAP\/CAF","","18","Select","Select",""],["","16729017217","AMITRIPTYLIN","25MG","30","Select","Select",""],["","69784018014","POLYETH","3350 NF","14","Select","Select",""],["","10702000709","CYCLOBENZAPR","10MG","12","Select","Select",""],["","00143924920","AMOX\/K","875-125","20","Select","Select",""],["","66993001968","ALBUTEROL","HFA","18","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":""}]}]}