{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" MICHELLE MONTGOMERY","gend":1,"add":"9600 GATES ROAD","city":"SUFFOLK","state":"VA","zip":"23437-9998","dob":"1962-08-25","age":"","mstatus":"","insh":"1533192*01","cliId":"","pno":"757\/742-2248","cno":"757\/742-2248, ","email":"","ename":"","eno":"","pphy":"PARSONS, DENISE MD","ppno":"757\/304-5570","pcpadd":"1357 ARMORY DRIVE","pcpcity":"FRANKLIN","pcpstate":"VA","pcpzip":"23851-9998","pcpcounty":"","pcpid":153229,"pcpname":"","plan":"OHP - OPTIMA","program":"ACA","lob":"Individual","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":["Z12.31","Z12.4","R06.02","J45.909","J44.9","J44.1","M51.37","F17.210","Z91.09","J32.9","Z11.59","Z00.00","J43.9","Z23.","F17.200","R06.2","Z72.0","Z71.6","Z12.39","J30.2","Z12.11","K21.9","R06.00"],"date":["2020-08-03","2020-08-11","2020-10-03","2021-05-13","2021-05-13","2020-10-03","2020-10-03","2020-10-03","2020-10-03","2020-06-20","2020-06-20","2020-07-23","2020-10-03","2020-09-01","2021-05-13","2020-07-23","2020-07-23","2020-07-23","2020-07-23","2020-07-23","2020-07-23","2020-07-23","2020-07-27"],"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":[["","66993001968","ALBUTEROL","HFA","18","Select","Select",""],["","00173068220","VENTOLIN","","18","Select","Select",""],["","00143924920","AMOX\/K","875-125","20","Select","Select",""],["","00310737020","BUDES\/FORMOT","160-4.5","10","Select","Select",""],["","00069047103","CHANTIX","0.5& 1MG","-53","Select","Select",""],["","16571040250","CETIRIZINE","10MG","30","Select","Select",""],["","00781286810","OMEPRAZOLE","20MG","30","Select","Select",""],["","00054327099","FLUTICASONE","50MCG","16","Select","Select",""],["","00186037020","SYMBICORT","160-4.5","-10","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","59746000106","METHYLPRED","4MG","21","Select","Select",""],["","59746017509","PREDNISONE","20MG","10","Select","Select",""],["","00143314250","DOXYCYCL","100MG","14","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":""}]}]}