{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BETHANY   S VAUGHAN","gend":1,"add":"2345 VAUGHAN RD","city":"VIRGINIA BEACH","state":"VA","zip":"23457-9998","dob":"1984-11-30","age":"","mstatus":"","insh":"1264670*01","cliId":"","pno":"757\/650-3342","cno":"757\/650-3342","email":"","ename":"","eno":"","pphy":"REED, SHARON B MD","ppno":"757\/622-8358","pcpadd":"930 W 21ST ST SUITE 100","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23517,"pcpcounty":"","pcpid":156143,"pcpname":"","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"757\/646-1937","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":["L71.0","E03.9","E53.8","E55.9","Z03.818","Z20.828","E08.9","Z20.822","K08.89","J02.9","H60.61","H90.3","Z11.59","L57.0","L21.8","L85.3","J01.20","Z86.16","R53.81"],"date":["2020-07-16","2021-10-29","2021-09-20","2021-10-29","2021-04-22","2021-04-22","2020-09-23","2021-02-15","2021-02-15","2021-02-15","2020-01-17","2020-01-17","2020-07-09","2021-07-20","2021-07-20","2021-07-20","2021-08-10","2021-09-20","2021-10-29"],"priorHcc":["",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":[["","69238183101","LEVOTHYROXIN","50MCG","-30","Select","Select",""],["","00093227434","AMOX\/K","500-125","20","Select","Select",""],["","53746051501","SPIRONOLACT","100MG","30","Select","Select",""],["","69238110005","DOXYCYCL","100MG","20","Select","Select",""],["","72356010103","AMZEEQ","4%","30","Select","Select",""],["","66993096045","METRONIDAZOL","0.75%","45","Select","Select",""],["","13107006101","PHENTERMINE","37.5MG","30","Select","Select",""],["","69238183101","LEVOTHYROXIN ","50MCG","30","Select","Select",""],["","69238110005","DOXYCYCL ","100MG","20","Select","Select",""],["","00093227434","AMOX\/K ","500-125","20","Select","Select",""],["","53746051501","SPIRONOLACT ","100MG","90","Select","Select",""],["","66993096045","METRONIDAZOL ","0.75%","45","Select","Select",""],["","72356010103","AMZEEQ ","4%","30","Select","Select",""],["","45802043733","CLOBETASOL ","0.05%","100","Select","Select",""],["","51672130009","AMMONIUM ","12%","400","Select","Select",""],["","00168008031","HYDROCORT ","2.50%","30","Select","Select",""],["","43598021040","SSD ","1%","400","Select","Select",""],["","13107006101","PHENTERMINE ","37.5MG","30","Select","Select",""],["","00781261305","AMOXICILLIN ","500MG","60","Select","Select",""],["","51672130009","AMMONIUM","12%","400","Select","Select",""],["","45802043733","CLOBETASOL","0.05%","100","Select","Select",""],["","00781261305","AMOXICILLIN","500MG","-60","Select","Select",""],["","43598021040","SSD","1%","400","Select","Select",""],["","00168008031","HYDROCORT","2.50%","30","Select","Select",""],["","31722072610","MONTELUKAST","10MG","90","Select","Select",""],["","00406012305","HYDROCO\/APAP ","TAB 5-325MG","10","Select","Select",""],["","31722072610","MONTELUKAST ","TAB 10MG","90","Select","Select",""],["","64380080807","IBUPROFEN ","TAB 600MG","90","Select","Select",""],["","57237007710","ONDANSETRON ","TAB 4MG ODT","12","Select","Select",""],["","52817033200","CYCLOBENZAPR ","TAB 10MG","15","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":[[["Yes","Select","","","","","Select","",""],["Yes","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":""}]}]}