{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ASHLIN JENKINS","gend":1,"add":"2029 HICKORYWOOD DR","city":"SUFFOLK","state":"VA","zip":"23434-9998","dob":"1986-06-20","age":"","mstatus":"","insh":"1784167*01","cliId":"","pno":"757\/610-7214","cno":"757\/610-7214","email":"","ename":"","eno":"","pphy":"MUGAISI, HESED N MD","ppno":"757\/738-1375","pcpadd":"148 BURNETTS WAY STE 107","pcpcity":"SUFFOLK","pcpstate":"VA","pcpzip":23434,"pcpcounty":"","pcpid":207896,"pcpname":"BON SECOURS SUFFOLK PRIMARY CARE","plan":"OHP","program":"ACA","lob":"Individual","region":"TIDEWATER","aligned":"","ano":"757\/610-7214","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/934-6935","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R10.2","Z30.017","R10.32","E87.6","Z87.11","G40.909","J45.909","R51.9","Z91.040","Z88.8","Z91.018","H53.8","N39.0","R39.9","R31.9","G40.009","R55.","G43.001","R19.7","Z87.19","Z79.899","R11.0","Z00.00","Z30.46","T42.3X1A","R42.","R53.1","Z01.411","G40.019","T42.0X1A","E86.0","R11.2","K21.9","K27.9","R53.81","R53.83","K52.9","G43.009","K31.84","J30.9","G43.909","K59.00","R20.0","R10.30","Z20.822"],"date":["2020-09-14","2020-10-01","2021-09-28","2020-04-03","2020-03-09","2021-04-15","2020-03-09","2021-04-15","2021-04-15","2021-04-15","2021-04-15","2021-04-15","2021-06-14","2021-06-14","2021-06-14","2020-09-08","2020-09-08","2020-09-08","2020-02-24","2020-02-24","2020-02-24","2021-09-28","2020-08-31","2020-10-30","2020-02-08","2020-02-08","2020-02-08","2020-08-31","2020-02-03","2020-02-03","2021-07-25","2020-02-03","2020-02-03","2020-02-03","2020-02-03","2020-02-03","2020-02-03","2020-02-03","2020-02-03","2020-02-03","2020-02-03","2020-02-03","2021-07-25","2021-08-07","2021-08-19"],"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":[["","13517011201","PHENOBARB","64.8MG","-30","Select","Select",""],["","70710122500","AMITRIPTYLIN","10MG","90","Select","Select",""],["","59762444002","METHYLPRED","4MG","-21","Select","Select",""],["","00832532511","POT CL MICRO","20MEQ ER","5","Select","Select",""],["","65862001501","AMOXICILLIN","875MG","20","Select","Select",""],["","00527600274","LIDOCAINE","2% VISC","-200","Select","Select",""],["","00143122710","DICYCLOMINE","20MG","30","Select","Select",""],["","00185012201","NITROFURANTN","100MG","14","Select","Select",""],["","60846050201","PYRIDIUM","200MG","6","Select","Select",""],["","70710122500","AMITRIPTYLIN ","10MG","90","Select","Select",""],["","13517011201","PHENOBARB ","64.8MG","75","Select","Select",""],["","59762444002","METHYLPRED ","4MG","-21","Select","Select",""],["","00143122710","DICYCLOMINE ","20MG","30","Select","Select",""],["","00832532511","POT  CL MICRO","20MEQ ER","5","Select","Select",""],["","00527600274","LIDOCAINE ","2% VISC","200","Select","Select",""],["","65862001501","AMOXICILLIN ","875MG","20","Select","Select",""],["","00185012201","NITROFURANTN ","100MG","14","Select","Select",""],["","60846050201","PYRIDIUM ","200MG","6","Select","Select",""],["","57237007710","ONDANSETRON ","4MG ODT","30","Select","Select",""],["","00781185220","AMOX\/K ","875-125","20","Select","Select",""],["","00781185220","AMOX\/K","875-125","20","Select","Select",""],["","57237007710","ONDANSETRON","4MG ODT","30","Select","Select",""],["","67877026218","RIZATRIPTAN ","TAB 10MG","9","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":""}]}]}