{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ANN   MARIE MCGEARY","gend":1,"add":"5108 HEMLOCK AVE","city":"VIRGINIA BEACH","state":"VA","zip":"23464-9998","dob":"1959-08-03","age":"","mstatus":"","insh":"1690938*02","cliId":"","pno":"757\/495-5938","cno":"757\/495-5938","email":"","ename":"","eno":"","pphy":"SZULC, SUSAN V MD","ppno":"757\/528-2761","pcpadd":"4867 BAXTER RD STE 105","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23462,"pcpcounty":"","pcpid":175410,"pcpname":"TPMG BEACH PRIMARY CARE","plan":"OHP","program":"ACA","lob":"Individual","region":"TIDEWATER","aligned":"","ano":"757\/495-5938","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/937-0435","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z12.31","L90.0","Z12.4","Z86.010","K64.0","L82.1","L81.4","Z00.00","B00.1","D70.9","Z68.23","Z23.","Z01.419","Z12.12","M51.16","M54.5","Z13.1","R79.89","D53.9","M54.16","M51.17","M47.27","M79.644","G89.29","R52.","M18.11"],"date":["2020-03-10","2021-02-03","2021-03-24","2020-06-17","2020-06-17","2021-02-03","2021-02-03","2021-04-02","2020-03-17","2020-03-17","2020-03-17","2021-06-10","2021-03-24","2021-03-24","2021-06-21","2021-06-21","2020-03-12","2020-03-12","2020-03-12","2021-08-02","2021-06-21","2021-06-21","2021-07-01","2021-07-01","2021-09-27","2021-09-27"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","",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":[["","58160082311","SHINGRIX","50\/0.5ML","1","Select","Select",""],["","31722070530","VALACYCLOVIR","1GM","12","Select","Select",""],["","66993087761","CALCIPOTRIEN","0.01%","60","Select","Select",""],["","45802006335","TRIAMCINOLON","0.03%","30","Select","Select",""],["","43386009660","CLOBETASOL","0.05%","30","Select","Select",""],["","00093026492","FLUOCINONIDE","0.05%","60","Select","Select",""],["","33332032001","AFLURIA","2020-21","0","Select","Select",""],["","58160084252","BOOSTRIX","","1","Select","Select",""],["","58160082311","SHINGRIX ","50\/0.5ML","-1","Select","Select",""],["","31722070530","VALACYCLOVIR ","1GM","-12","Select","Select",""],["","66993087761","CALCIPOTRIEN ","0.01%","60","Select","Select",""],["","45802006335","TRIAMCINOLON ","0.03%","30","Select","Select",""],["","00093026492","FLUOCINONIDE ","0.05%","-60","Select","Select",""],["","43386009660","CLOBETASOL ","0.05%","30","Select","Select",""],["","58160084252","BOOSTRIX ","","1","Select","Select",""],["","33332032001","AFLURIA ","2020-21","0","Select","Select",""],["","49281042150","FLUZONE","2021-22","0","Select","Select",""],["","60505056000","OFLOXACIN","0.3% OP","5","Select","Select",""],["","60505056000","OFLOXACIN ","DRO 0.3% OP","-5","Select","Select",""],["","49281042150","FLUZONE ","INJ 2021-22","0","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":""}]}]}