{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" MARIE THOMPSON","gend":1,"add":"1921 SUMMERWALK DR","city":"VIRGINIA BEACH","state":"VA","zip":"23456-9998","dob":"1955-06-24","age":"","mstatus":"","insh":"1695516*01","cliId":"","pno":"757\/286-8855","cno":"757\/286-8855, ","email":"","ename":"","eno":"","pphy":"CHOU, KEVIN MD","ppno":"757\/686-3515","pcpadd":"2088 S INDEPENDENCE BLVD","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":"23453-9998","pcpcounty":"","pcpid":172075,"pcpname":"Nowcare Princess Anne","plan":"OHP - OPTIMA","program":"ACA","lob":"Individual","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":["K64.8","M25.512","S49.92XA","K64.9","S00.93XA","E03.9","Z79.82","Z79.899","Z88.8","S39.91XA","S39.93XA","S29.9XXA","S06.0X9A","Z01.419","Z11.51","Z11.3","F43.22","I72.6","L90.5","Z71.9","S06.0X9D","V29.9XXD","M54.2","R07.81","M54.6","Z98.890","Z13.89","E55.9","Z95.828","I67.1","V29.9XXA","S16.1XXA","S29.019A","M75.42","M99.01","M99.08","M99.02","S01.81XA","M25.552","M25.511","M25.571","K57.30","M50.322","M51.36","J98.11","Z88.6","Z95.820","Z79.1","Z79.890","S09.90XA","G89.11","Z12.31","S00.03XA","S10.83XA","S80.01XA","S80.12XA","S90.02XA","S90.32XA","F41.9","Z68.25","M54.5","M79.18","R51.","V27.5XXA","S49.91XA","M79.605","S79.922A","S99.911A","S19.9XXA","S06.0X0A"],"date":["2020-03-05","2020-09-15","2020-05-23","2020-02-24","2020-05-23","2020-05-23","2020-05-23","2020-05-23","2020-05-23","2020-05-23","2020-05-23","2020-05-23","2020-08-06","2020-12-18","2020-12-14","2020-12-14","2021-03-09","2020-12-30","2020-09-03","2020-09-03","2020-11-19","2020-11-19","2020-09-15","2020-09-15","2020-09-15","2020-09-15","2020-12-18","2020-12-18","2020-12-21","2020-12-21","2020-06-05","2020-09-08","2020-09-08","2020-09-08","2020-11-19","2020-11-19","2020-11-19","2020-05-23","2020-05-23","2020-05-23","2020-05-23","2020-05-23","2020-05-23","2020-05-23","2020-05-23","2020-05-23","2020-05-23","2020-05-23","2020-05-23","2020-05-23","2020-05-23","2020-01-06","2020-05-25","2020-05-25","2020-05-25","2020-05-25","2020-05-25","2020-05-25","2020-05-25","2020-11-19","2020-11-19","2020-11-19","2020-05-23","2020-05-23","2020-05-23","2020-05-23","2020-05-23","2020-05-23","2020-05-23","2020-05-28"],"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":[["","42858010201","OXYCOD\/APAP","5-325MG","-40","Select","Select",""],["","00074455290","SYNTHROID","50MCG","30","Select","Select",""],["","65862039010","ONDANSETRON","4MG ODT","10","Select","Select",""],["","52817033200","CYCLOBENZAPR","10MG","15","Select","Select",""],["","11822013729","RA","100MG","30","Select","Select",""],["","00597002402","COMBIVENT","20-100","-4","Select","Select",""],["","16714038801","CEFADROXIL","500MG","14","Select","Select",""],["","31722099601","HYDROCO\/APAP","5-325MG","20","Select","Select",""],["","00378427593","VALACYCLOVIR","500MG","14","Select","Select",""],["","51672400101","NORTRIPTYLIN","10MG","270","Select","Select",""],["","17478007035","ERYTHROMYCIN","5MG\/GM","4","Select","Select",""],["","65862015901","ZOLPIDEM","5MG","30","Select","Select",""],["","13668044201","CELECOXIB","200MG","2","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":""}]}]}