{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" PAMELA R DILDY","gend":1,"add":"1015 LAKE KENNEDY DR","city":"SUFFOLK","state":"VA","zip":"23434-9998","dob":"1968-02-20","age":"","mstatus":"","insh":"1577638*01","cliId":"","pno":"757\/934-1677","cno":"757\/934-1677, 757\/334-2341","email":"","ename":"","eno":"","pphy":"MAPANAO, VIVIAN MD","ppno":"757\/484-3472","pcpadd":"5622 BENNETTS PASTURE RD","pcpcity":"SUFFOLK","pcpstate":"VA","pcpzip":"23435-9998","pcpcounty":"","pcpid":138558,"pcpname":"Bridge Road Family Medicine","plan":"OHP - OPTIMA","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":["E53.8","E55.9","E78.5","E11.9","J06.9","K59.09","M67.813","M85.611","Z12.31","D50.8","M54.9","M79.621","Z01.419","R10.9","D50.9","R53.83","Z79.899","M54.2","E11.3293","H04.123","H25.13","H35.3131","E11.319","D64.9","R07.9","K59.04","Z86.010","Z68.28","E66.9","R05.","Z20.828","N39.0","R74.8","Z96.89","K59.00","K27.9","K21.9","K44.9","M20.10","R53.82","M25.511","G89.29","M54.6","M65.311","M50.11","Z09.","Z98.890","M75.01"],"date":["2021-04-23","2021-04-23","2021-04-23","2021-04-23","2020-07-29","2021-02-17","2021-03-15","2021-03-15","2020-08-10","2021-05-03","2021-05-31","2021-05-31","2020-08-10","2021-02-19","2021-05-03","2021-05-03","2020-10-12","2021-04-23","2020-07-21","2020-07-21","2020-07-21","2020-07-21","2020-07-21","2021-04-23","2021-01-14","2021-05-20","2021-02-19","2021-02-02","2021-05-20","2020-07-29","2020-07-29","2020-11-12","2021-02-11","2021-02-19","2021-04-23","2021-04-23","2021-04-23","2021-04-23","2021-04-23","2021-05-03","2021-05-10","2021-05-10","2020-04-20","2020-10-08","2020-12-03","2020-01-20","2020-01-20","2021-06-15"],"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":[["","08290320122","BD PEN NEEDL","32GX4MM","-500","Select","Select",""],["","31722094101","HYDROCO\/APAP","5-325MG","21","Select","Select",""],["","00006027754","JANUVIA","100MG","-90","Select","Select",""],["","00088221905","LANTUS","100\/ML","15","Select","Select",""],["","00002879959","HUMALOG","100\/ML","15","Select","Select",""],["","64380073706","VITAMIN","50000UNT","6","Select","Select",""],["","57237002501","GLYB\/METFORM","5-500MG","180","Select","Select",""],["","68462010340","FLUCONAZOLE","150MG","1","Select","Select",""],["","68645055054","LISINOPRIL","2.5MG","90","Select","Select",""],["","00093505898","ATORVASTATIN","40MG","-90","Select","Select",""],["","00456120230","LINZESS","290MCG","90","Select","Select",""],["","59762002901","DICLO\/MISOPR","75-0.2MG","180","Select","Select",""],["","10702000709","CYCLOBENZAPR","10MG","90","Select","Select",""],["","47781030301","NITROFURANTN","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":[[["Yes","Select","","","","","Select","",""],["Yes","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":""}]}]}