{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BRITTANY KEY","gend":1,"add":"336 PAXFORD DR","city":"VIRGINIA BEACH","state":"VA","zip":"23462-9998","dob":"1989-08-30","age":"","mstatus":"","insh":"1663512*01","cliId":"","pno":"757\/576-1822","cno":"757\/576-1822","email":"","ename":"","eno":"","pphy":"GIANVITTORIO, JOY M MD","ppno":"757\/499-5550","pcpadd":"SUITE 102 351 EDWIN DR","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23462,"pcpcounty":"","pcpid":126202,"pcpname":"HOLLAND ROAD FAMILY MEDICINE","plan":"OHP","program":"ACA","lob":"Individual","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/473-0919","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J32.9","G35.","R90.82","J10.1","G65.0","R53.83","Z51.81","E55.9","H65.90","G93.89","Z97.5","G93.9","F41.1","E03.9","E51.9","E71.120","E78.5","Z00.00","Z13.818","R07.89"],"date":["2020-05-14","2021-10-27","2021-03-05","2020-03-01","2020-04-23","2021-08-31","2021-02-05","2021-10-15","2020-01-10","2021-03-19","2021-03-19","2021-03-19","2021-10-22","2021-10-15","2021-10-15","2021-10-15","2021-10-15","2021-10-15","2021-10-15","2021-09-13"],"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":[["","58468021004","AUBAGIO","14MG","30","Select","Select",""],["","70710101002","OSELTAMIVIR","75MG","-10","Select","Select",""],["","42543049701","AMANTADINE","100MG","-60","Select","Select",""],["","65862064163","AZITHROMYCIN","250MG","6","Select","Select",""],["","00603533715","PREDNISONE","5MG","21","Select","Select",""],["","00172392670","DIAZEPAM","5MG","4","Select","Select",""],["","00603533715","PREDNISONE ","5MG","21","Select","Select",""],["","65862064163","AZITHROMYCIN ","250MG","6","Select","Select",""],["","58468021004","AUBAGIO ","14MG","30","Select","Select",""],["","70710101002","OSELTAMIVIR ","75MG","-10","Select","Select",""],["","42543049701","AMANTADINE ","100MG","60","Select","Select",""],["","00172392670","DIAZEPAM ","5MG","-4","Select","Select",""],["","42806054701","VITAMIN","1.25MG","12","Select","Select",""],["","42806054701","VITAMIN ","CAP 1.25MG","-12","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":""}]}]}