{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JANA JONES","gend":1,"add":"8313 N VIEW BLVD","city":"NORFOLK","state":"VA","zip":"23518-9998","dob":"1968-08-10","age":"","mstatus":"","insh":"1630859*01","cliId":"","pno":"757\/636-2490","cno":"757\/636-2490","email":"","ename":"","eno":"","pphy":"ROBERTSON, CHARLENE MD","ppno":"757\/623-6072","pcpadd":"426 E FREEMASON ST","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23510,"pcpcounty":"","pcpid":100004,"pcpname":"Associates in Primary Care, PC","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/623-9748","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J15.9","Z12.4","R50.9","Z12.31","Z01.419","J18.8","J18.9","J18.1","A41.9","Z00.00","Z80.0","Z13.1","Z13.220","D47.3","R00.0","E86.0","Z12.11","Z12.12"],"date":["2020-02-28","2021-04-01","2020-01-20","2020-11-04","2021-04-01","2020-01-17","2020-01-23","2020-01-23","2020-01-23","2021-04-13","2021-04-13","2021-04-13","2021-04-13","2021-07-19","2020-01-20","2020-01-20","2020-05-01","2020-05-01"],"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":[["","58657050016","CODEINE\/GG ","10-100\/5","120","Select","Select",""],["","65862050320","AMOX\/K ","875-125","-20","Select","Select",""],["","50261021130","BIJUVA ","1-100MG","30","Select","Select",""],["","69452023420","PROGESTERONE ","200MG","-30","Select","Select",""],["","68180016113","AZITHROMYCIN ","500MG","1","Select","Select",""],["","67877057505","BENZONATATE ","200MG","-30","Select","Select",""],["","50428919047","DIGES ","250MG","20","Select","Select",""],["","33332032001","AFLURIA ","2020-21","0","Select","Select",""],["","00378462226","ESTRADIOL ","0.075MG","-8","Select","Select",""],["","58657050016","CODEINE\/GG","10-100\/5","120","Select","Select",""],["","65862050320","AMOX\/K","875-125","20","Select","Select",""],["","50261021130","BIJUVA","1-100MG","30","Select","Select",""],["","67877057505","BENZONATATE","200MG","30","Select","Select",""],["","68180016113","AZITHROMYCIN","500MG","-1","Select","Select",""],["","50428919047","DIGES","250MG","20","Select","Select",""],["","33332032001","AFLURIA","2020-21","0","Select","Select",""],["","00378462226","ESTRADIOL","0.075MG","8","Select","Select",""],["","69452023420","PROGESTERONE","200MG","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":""}]}]}