{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KIMBERLY   H BOHNSLAV","gend":1,"add":"2914 SEASHORE PT","city":"VIRGINIA BEACH","state":"VA","zip":"23454-9998","dob":"1961-03-25","age":"","mstatus":"","insh":"1267803*01","cliId":"","pno":"757\/642-2532","cno":"757\/642-2532","email":"","ename":"","eno":"","pphy":"MCDERMOTT, GLENN MD","ppno":"757\/412-0006","pcpadd":"1368 N GREAT NECK RD","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23454,"pcpcounty":"","pcpid":165136,"pcpname":"","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"757\/426-6214","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/496-2069","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F32.9","F41.1","Z13.820","M85.80","N60.92","E55.9","N60.89","Z78.0","Z85.3","Z88.5","Z98.82","M48.062","M51.16","M51.17","M47.26","M47.27","M54.16","M47.816","M51.36","M48.061","E78.2","E03.9","Z82.49","Z79.899","M54.5","B02.9","E03.8","Z12.31","N60.82","M54.9","E07.9","M54.2","M54.12","J44.9","Z00.00","E06.5","E06.3","D48.5","R05.","G47.00","F10.21","F33.1","F51.01","M85.88","H43.813","F10.239","F10.20","F33.2","F41.9","J45.909","Z20.822"],"date":["2020-04-03","2020-04-03","2020-07-02","2020-11-03","2020-07-02","2020-07-02","2020-11-03","2020-07-02","2020-07-02","2020-07-02","2020-07-02","2020-08-18","2020-08-18","2020-08-18","2020-08-18","2020-08-18","2021-02-19","2021-02-19","2020-08-20","2021-02-19","2021-09-02","2021-09-02","2020-09-01","2021-09-02","2020-12-04","2020-10-04","2021-01-08","2021-06-16","2020-11-03","2020-11-03","2021-09-02","2020-08-04","2020-08-04","2021-06-10","2020-06-24","2020-01-08","2020-03-09","2020-08-28","2020-02-06","2020-03-20","2020-03-20","2020-04-03","2020-03-13","2020-07-02","2021-10-12","2020-01-24","2020-02-24","2020-02-24","2021-09-02","2021-06-17","2021-09-22"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",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":[["","00186037020","SYMBICORT","160-4.5","10","Select","Select",""],["","69238183407","LEVOTHYROXIN","100MCG","90","Select","Select",""],["","69097082502","RALOXIFENE","60MG","90","Select","Select",""],["","00310737020","BUDES\/FORMOT","160-4.5","10","Select","Select",""],["","37864090501","VITAMIN","100MG","15","Select","Select",""],["","51991070505","ALPRAZOLAM","0.5MG","24","Select","Select",""],["","00555015902","CHLORDIAZEP","25MG","20","Select","Select",""],["","75987001003","DUEXIS","800-26.6","90","Select","Select",""],["","70436001006","BUPROPN","150MG XL","30","Select","Select",""],["","58160082311","SHINGRIX","50\/0.5ML","1","Select","Select",""],["","65862029590","ROSUVASTATIN","20MG","30","Select","Select",""],["","00173068220","VENTOLIN","","18","Select","Select",""],["","66993058597","FLUTIC\/SALME","250\/50","60","Select","Select",""],["","31722070590","VALACYCLOVIR","1GM","21","Select","Select",""],["","00310461612","BREZTRI","SPHERE","11","Select","Select",""],["","58160088552","FLUARIX","2020-21","0","Select","Select",""],["","69238183407","LEVOTHYROXIN ","100MCG","90","Select","Select",""],["","00186037020","SYMBICORT ","160-4.5","10","Select","Select",""],["","00555015902","CHLORDIAZEP ","25MG","20","Select","Select",""],["","37864090501","VITAMIN ","100MG","15","Select","Select",""],["","51991070505","ALPRAZOLAM ","0.5MG","24","Select","Select",""],["","69097082502","RALOXIFENE ","60MG","90","Select","Select",""],["","75987001003","DUEXIS ","800-26.6","90","Select","Select",""],["","00173068220","VENTOLIN ","","18","Select","Select",""],["","00310737020","BUDES\/FORMOT ","160-4.5","10","Select","Select",""],["","66993058597","FLUTIC\/SALME ","250\/50","60","Select","Select",""],["","70436001006","BUPROPN ","150MG XL","90","Select","Select",""],["","65862029590","ROSUVASTATIN ","20MG","90","Select","Select",""],["","58160088552","FLUARIX ","2020-21","0","Select","Select",""],["","31722070590","VALACYCLOVIR ","1GM","21","Select","Select",""],["","58160082311","SHINGRIX ","50\/0.5ML","1","Select","Select",""],["","00310461612","BREZTRI ","SPHERE","11","Select","Select",""],["","49281072110","FLUBLOK","2021-22","0","Select","Select",""],["","59267100002","PFIZER ","INJ COVID-19","0","Select","Select",""],["","49281072110","FLUBLOK ","INJ 2021-22","0","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":""}]}]}