{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"AVA   M WOODELL","gend":1,"add":"4908 KLAMATH RD","city":"VIRGINIA BEACH","state":"VA","zip":"23462-9998","dob":"2003-06-07","age":"","mstatus":"","insh":"1507648*04","cliId":"","pno":"757\/497-4534","cno":"757\/497-4534","email":"","ename":"","eno":"","pphy":"BYMAN, ERIC MD","ppno":"757\/333-7625","pcpadd":"4501 N WITCHDUCK ROAD SUITE B","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23455,"pcpcounty":"","pcpid":126202,"pcpname":"INDEPENDENCE FAMILY MEDICINE","plan":"OHP","program":"ACA","lob":"Small Group","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":["N84.0","F53.0","N93.9","Z20.828","R05.","R68.83","R53.83","R51.9","M79.10","R63.0","Z30.42","O70.0","Z37.0","Z3A.39","O09.613","Z32.02","Z34.02","O80.","N39.0","Z36.9","J00.","Z33.1","H66.92","H60.92","Z39.2","Z30.40","Z20.822","N93.8","O72.1","F32.9","N30.01","U07.1","N92.6"],"date":["2021-03-27","2021-05-06","2021-03-02","2021-02-18","2021-02-18","2021-02-18","2021-02-18","2021-02-18","2021-02-18","2021-02-18","2021-05-17","2020-05-04","2020-05-05","2020-05-05","2020-05-04","2021-05-17","2020-11-25","2020-05-05","2021-07-14","2020-04-16","2020-03-04","2020-03-04","2020-05-21","2020-05-21","2020-06-09","2020-06-09","2021-02-18","2020-06-06","2020-06-06","2021-09-07","2021-09-13","2021-09-13","2021-11-09"],"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":[["","50111043302","TRAZODONE ","50MG","90","Select","Select",""],["","00781808926","AZITHROMYCIN ","250MG","6","Select","Select",""],["","69238126601","OSELTAMIVIR ","75MG","20","Select","Select",""],["","60258017901","PRENATAL-U ","106.5-1","30","Select","Select",""],["","00406051205","OXYCOD\/APAP ","5-325MG","15","Select","Select",""],["","57237002901","AMOXICILLIN ","875MG","20","Select","Select",""],["","24208063562","NEO\/POLY\/HC ","1% OTIC","10","Select","Select",""],["","64380080807","IBUPROFEN ","600MG","20","Select","Select",""],["","59762453701","MEDROXYPR ","150MG\/ML","1","Select","Select",""],["","00093585201","ESCITALOPRAM ","20MG","30","Select","Select",""],["","68682030601","BUTALB\/ACETA ","50-300MG","60","Select","Select",""],["","69918030130","TRANEX ","650MG","30","Select","Select",""],["","49281042050","FLUZONE ","2020-21","0","Select","Select",""],["","51293061201","PHENAZOPYRID ","200MG","-6","Select","Select",""],["","00185012201","NITROFURANTN ","100MG","10","Select","Select",""],["","60846050201","PYRIDIUM ","200MG","6","Select","Select",""],["","50111043302","TRAZODONE","50MG","90","Select","Select",""],["","69238126601","OSELTAMIVIR","75MG","20","Select","Select",""],["","00781808926","AZITHROMYCIN","250MG","-6","Select","Select",""],["","60258017901","PRENATAL-U","106.5-1","-30","Select","Select",""],["","64380080807","IBUPROFEN","600MG","20","Select","Select",""],["","57237002901","AMOXICILLIN","875MG","20","Select","Select",""],["","24208063562","NEO\/POLY\/HC","1% OTIC","10","Select","Select",""],["","59762453701","MEDROXYPR","150MG\/ML","-1","Select","Select",""],["","00406051205","OXYCOD\/APAP","5-325MG","15","Select","Select",""],["","00093585201","ESCITALOPRAM","20MG","30","Select","Select",""],["","68682030601","BUTALB\/ACETA","50-300MG","60","Select","Select",""],["","49281042050","FLUZONE","2020-21","0","Select","Select",""],["","69918030130","TRANEX","650MG","30","Select","Select",""],["","00185012201","NITROFURANTN","100MG","-14","Select","Select",""],["","51293061201","PHENAZOPYRID","200MG","-6","Select","Select",""],["","60846050201","PYRIDIUM","200MG","6","Select","Select",""],["","67877022005","CEPHALEXIN","250MG","40","Select","Select",""],["","65862039010","ONDANSETRON","4MG ODT","10","Select","Select",""],["","65862039010","ONDANSETRON ","TAB 4MG ODT","10","Select","Select",""],["","67877022005","CEPHALEXIN ","CAP 250MG","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":""}]}]}