{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"AMALIA   S MOZOL","gend":1,"add":"720 LANCE DR","city":"NEWPORT NEWS","state":"VA","zip":"23601-9998","dob":"1951-10-22","age":"","mstatus":"","insh":"1516963*01","cliId":"","pno":"757\/595-6069","cno":"757\/595-6069","email":"","ename":"","eno":"","pphy":"ALBAND, WENDY F MD","ppno":"757\/738-1200","pcpadd":"4039 E LITTLE CREEK RD","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23518,"pcpcounty":"","pcpid":207889,"pcpname":"EAST BEACH MEDICAL ASSOCIATES","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"757\/813-5473","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":["R07.9","R20.2","R42.","M79.7","D56.9","Z88.6","Z88.8","M79.603","J02.9","R68.89","I34.0","E78.00","R73.03","I51.89","R20.0","R05.","Z12.31","R55.","R94.30","I20.9","Z78.0","M85.89","G56.01","G56.02","R56.9","Z00.00","D56.3","M85.80","G56.03","M19.041","M85.88","Z79.899","M24.842","M24.841","B34.9","Z20.822","Z12.11","K59.00"],"date":["2020-01-31","2020-01-31","2020-02-18","2020-01-31","2020-01-31","2020-01-31","2020-01-31","2020-01-31","2020-02-07","2020-02-07","2020-02-18","2021-11-12","2021-11-12","2021-11-12","2020-02-07","2020-02-07","2021-11-12","2020-09-01","2020-09-01","2020-09-01","2021-01-07","2021-01-07","2020-03-23","2020-03-23","2020-03-12","2020-11-12","2021-05-06","2021-01-07","2020-05-28","2020-02-07","2021-01-07","2021-01-07","2020-02-07","2020-02-07","2021-08-09","2021-08-09","2021-11-12","2021-11-12"],"priorHcc":["","","","","","","","","","","",null,null,null,"","",null,"","","","","","","","","","","","","","","","","",null,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":[["","64380071206","BENZONATATE","100MG","30","Select","Select",""],["","00054327099","FLUTICASONE","50MCG","-16","Select","Select",""],["","65862064169","AZITHROMYCIN","250MG","6","Select","Select",""],["","00781569031","EZETIMIBE","10MG","90","Select","Select",""],["","68382056501","METOPROL","50MG ER","90","Select","Select",""],["","43598081115","CETIRIZINE","10MG","30","Select","Select",""],["","49281012065","FLUZONE","PF 20-21","1","Select","Select",""],["","59267100001","PFIZER","COVID-19","0","Select","Select",""],["","45963067611","METOPROLOL","50MG ER","90","Select","Select",""],["","43598043611","NITROGLYCERN","0.4MG","50","Select","Select",""],["","65862064169","AZITHROMYCIN ","250MG","-6","Select","Select",""],["","00054327099","FLUTICASONE ","50MCG","16","Select","Select",""],["","64380071206","BENZONATATE ","100MG","30","Select","Select",""],["","43598081115","CETIRIZINE ","10MG","30","Select","Select",""],["","00781569031","EZETIMIBE ","10MG","90","Select","Select",""],["","68382056501","METOPROL ","50MG ER","30","Select","Select",""],["","45963067611","METOPROLOL ","50MG ER","90","Select","Select",""],["","49281012065","FLUZONE ","PF 20-21","1","Select","Select",""],["","59267100001","PFIZER ","COVID-19","0","Select","Select",""],["","43598043611","NITROGLYCERN ","0.4MG","50","Select","Select",""],["","11523433201","CLARITIN-D ","10-240MG","7","Select","Select",""],["","11523433201","CLARITIN-D","10-240MG","7","Select","Select",""],["","50428348642","CVS ","CAP 0.52GM","30","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":""}]}]}