{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"AMY   D MILLER","gend":1,"add":"5372 BLACKWATER RD","city":"VIRGINIA BEACH","state":"VA","zip":"23457-9998","dob":"1976-02-20","age":"","mstatus":"","insh":"1320516*02","cliId":"","pno":"757\/421-0378","cno":"757\/421-0378","email":"","ename":"","eno":"","pphy":"TAN-GONZALES, DESIREE MD","ppno":"757\/548-0076","pcpadd":"725 VOLVO PKWY SUITE 100","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":23320,"pcpcounty":"","pcpid":129852,"pcpname":"Volvo Medical Associates","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"757\/482-3667","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/548-1652","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["L40.0","L40.9","Z79.899","Z71.9","Z01.419","Z12.4","Z12.31","N92.0","Z71.6","F17.290","Z00.00","L60.1","L23.4","Z28.21","Z11.1","L29.9","L81.4","L82.1","Z12.39","I47.1","Z72.0"],"date":["2021-06-07","2021-06-22","2021-06-22","2020-11-30","2021-03-29","2021-03-29","2021-05-24","2021-03-29","2020-03-06","2020-03-06","2021-08-23","2020-11-30","2020-02-03","2020-06-05","2021-06-07","2020-05-04","2021-06-22","2021-06-22","2021-06-28","2021-08-23","2021-08-23"],"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":[["","00074153903","HUMIRA","PS\/UV","3","Select","Select",""],["","00074204202","SKYRIZI","150DOSE","-1","Select","Select",""],["","70700010617","CLOBETASOL","0.05%","120","Select","Select",""],["","00555077902","MEDROXYPR","10MG","7","Select","Select",""],["","52565005626","TRIAMCINOLON","0.10%","454","Select","Select",""],["","65162046510","IBUPROFEN","600MG","60","Select","Select",""],["","00074153903","HUMIRA ","PS\/UV","3","Select","Select",""],["","45802096126","CLOBETASOL ","0.05%","118","Select","Select",""],["","00074204202","SKYRIZI ","150DOSE","-1","Select","Select",""],["","67877025145","TRIAMCINOLON ","0.10%","454","Select","Select",""],["","65162046510","IBUPROFEN ","600MG","60","Select","Select",""],["","00555077902","MEDROXYPR ","10MG","7","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":""}]}]}