{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LAURA   M CISCO","gend":1,"add":"540 BOSTON AVE","city":"CHESAPEAKE","state":"VA","zip":"23322-9998","dob":"1986-06-29","pno":"757\/630-7358","cno":"757\/630-7358","email":"","pphy":"","ppno":"","pcpadd":"","pcpcity":"","pcpstate":"","pcpzip":"","pcpcounty":"","pcpid":"","pcpname":"","insh":"1253819*02","cliId":"","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"757\/364-5734","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":["O26.849","O34.41","Z3A.12","Z34.92","Z3A.15","O34.42","Z3A.24","Z34.00","R10.2","Z23.","Z01.84","O36.8130","O41.03X0","Z3A.34","Z37.0","O99.02","D64.9","O99.334","F17.210","O82.","Z30.430","D22.5","Q84.8","L85.3","Z34.91","Z13.79","O26.892","Z3A.14","Z36.89","Z3A.00","P96.89","R09.89","Z00.00","R06.02","R00.2","O36.8190","O41.00X0","S62.650A","M79.644","Z3A.08","Z36.0","Z3A.20","Z20.828","Z00.110","L22.","P07.37","Z32.02","K59.00","Z3A.28","K04.90","Z30.431","N93.9"],"date":["2020-07-29","2020-09-02","2020-09-02","2020-12-22","2020-09-24","2020-11-18","2020-11-24","2020-07-18","2020-10-12","2020-10-09","2021-01-26","2021-02-02","2021-02-02","2021-02-02","2021-02-02","2021-02-02","2021-02-02","2021-02-02","2021-02-02","2021-02-02","2021-04-14","2021-07-15","2021-07-15","2021-07-15","2020-08-12","2020-08-12","2020-10-12","2020-10-12","2020-10-12","2021-02-02","2021-02-02","2021-02-02","2020-10-12","2021-01-26","2021-01-26","2021-02-02","2021-02-02","2020-01-06","2020-01-13","2020-08-06","2020-10-27","2020-10-27","2021-01-26","2021-02-11","2021-02-11","2021-02-11","2021-04-14","2020-09-02","2020-12-22","2021-04-25","2021-05-12","2021-05-12"],"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":[["","55111015330","ONDANSETRON","4MG","30","Select","Select",""],["","42858010201","OXYCOD\/APAP","5-325MG","30","Select","Select",""],["","65162047810","NITROFURANTN","100MG","20","Select","Select",""],["","43386016106","MISOPROSTOL","200MCG","1","Select","Select",""],["","67877021905","CEPHALEXIN","500MG","21","Select","Select",""],["","63304069301","CLINDAMYCIN","300MG","40","Select","Select",""],["","55111015330","ONDANSETRON ","TAB 4MG","30","Select","Select",""],["","65162047810","NITROFURANTN ","CAP 100MG","20","Select","Select",""],["","43386016006","MISOPROSTOL ","TAB 100MCG","-1","Select","Select",""],["","67877021905","CEPHALEXIN ","CAP 500MG","-21","Select","Select",""],["","42858010201","OXYCOD\/APAP ","TAB 5-325MG","30","Select","Select",""],["","63304069301","CLINDAMYCIN ","CAP 300MG","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","",""],["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":""}]}]}