{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ANDREA   P WILLIAMS","gend":1,"add":"PO BOX 14050","city":"CHESAPEAKE","state":"VA","zip":"23325-9998","dob":"1967-10-06","age":"","mstatus":"","insh":"1691389*01","cliId":"","pno":"757\/589-1988","cno":"757\/589-1988","email":"","ename":"","eno":"","pphy":"PARAGAS, FLORENCE V MD","ppno":"757\/424-5778","pcpadd":"1200 S MILITARY HWY","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":23320,"pcpcounty":"","pcpid":100154,"pcpname":"","plan":"OHP","program":"ACA","lob":"Individual","region":"TIDEWATER","aligned":"","ano":"757\/589-1988","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/523-6542","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I10.","R51.","R05.","Z21.","Z88.6","N64.89","E04.9","B20.","Z03.89","Z00.00","K75.9","E78.5","R73.03","Z12.11","K57.30","K64.9","G43.909","Z98.890","Z23.","Z12.31","E04.2","M25.521","M77.11","R92.8","J84.10","D64.9","K57.90","K63.5","Z01.810","R94.31","N60.02","N60.01","D73.89","N60.12","Z01.419","N85.2","E06.3","Z88.8","Z79.899","G51.8","E89.0","N84.1","Z09.","Z01.812","N85.8","J45.909","Z79.890","Z98.51","Z78.0"],"date":["2021-10-07","2020-08-13","2020-08-13","2021-10-07","2021-10-07","2021-06-08","2021-08-24","2021-09-28","2020-02-05","2020-02-05","2021-09-07","2021-09-07","2021-09-07","2020-08-31","2020-08-13","2020-08-13","2020-08-13","2020-08-13","2020-09-22","2020-11-21","2021-09-21","2020-12-07","2020-12-07","2021-06-08","2021-06-22","2020-05-12","2020-08-13","2020-08-13","2021-06-22","2021-06-22","2020-12-08","2020-12-08","2021-06-22","2020-12-08","2021-08-11","2021-10-07","2021-09-08","2021-10-07","2021-10-07","2021-09-08","2021-11-16","2021-10-08","2021-10-25","2021-10-01","2021-10-07","2021-10-07","2021-10-07","2021-10-07","2021-10-07"],"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":[["","59676080030","SYMTUZA ","","30","Select","Select",""],["","62756052069","SUMATRIPTAN ","25MG","15","Select","Select",""],["","52268001201","SUPREP ","PREP KIT","354","Select","Select",""],["","29300012810","HYDROCHLOROT ","25MG","14","Select","Select",""],["","29300018901","BISOPRL\/HCTZ ","10\/6.25","90","Select","Select",""],["","49502010202","EPINEPHRINE ","0.3MG","2","Select","Select",""],["","59676080030","SYMTUZA","","30","Select","Select",""],["","62756052069","SUMATRIPTAN","25MG","15","Select","Select",""],["","52268001201","SUPREP","PREP KIT","354","Select","Select",""],["","29300018901","BISOPRL\/HCTZ","10\/6.25","-90","Select","Select",""],["","29300012810","HYDROCHLOROT","25MG","-14","Select","Select",""],["","49502010202","EPINEPHRINE","0.3MG","2","Select","Select",""],["","68180012202","CEPHALEXIN","500MG","21","Select","Select",""],["","65862039110","ONDANSETRON","8MG ODT","12","Select","Select",""],["","69238183801","LEVOTHYROXIN","150MCG","30","Select","Select",""],["","00904188372","OYSTER","500MG","84","Select","Select",""],["","42858010250","OXYCOD\/APAP","5-325MG","10","Select","Select",""],["","68180012202","CEPHALEXIN ","CAP 500MG","21","Select","Select",""],["","00904188372","OYSTER ","TAB 500MG","84","Select","Select",""],["","00378181577","LEVOTHYROXIN ","TAB 150MCG","-30","Select","Select",""],["","42858010201","OXYCOD\/APAP ","TAB 5-325MG","-30","Select","Select",""],["","65862039110","ONDANSETRON ","TAB 8MG ODT","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":[[["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":""}]}]}