{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JANET   ELAINE CHIPMAN","gend":1,"add":"1101 CAROLINA ROAD","city":"SUFFOLK","state":"VA","zip":"23434-9998","dob":"1954-12-23","pno":"757\/935-5338","cno":"757\/935-5338","email":"","pphy":"JONES, SHAVON C MD","ppno":"","pcpadd":"157 N MAIN ST","pcpcity":"SUFFOLK","pcpstate":"VA","pcpzip":23434,"pcpcounty":"","pcpid":116807,"pcpname":"","insh":"1784450*01","cliId":"","plan":"OHP","program":"ACA","lob":"Individual","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/928-0902","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R30.0","E11.65","I10.","I50.43","I34.0","I87.2","Z12.11","R06.09","J81.0","I36.1","I35.1","R06.00","R60.0","I50.40","I89.0","I42.9","I11.0","E78.5","E11.69","I50.42","E11.9","E66.01","E78.2","N39.0","I08.3","I25.10","R35.0","Z87.440","R91.8","R82.90","I42.0","Z90.49","Z87.891","Z79.899","Z79.84","Z85.41","Z68.41","Z00.00"],"date":["2020-11-10","2021-06-01","2021-08-23","2021-04-29","2021-04-29","2021-06-01","2021-05-23","2021-04-27","2021-03-23","2021-04-27","2021-04-27","2021-04-27","2021-04-27","2021-06-01","2021-06-01","2021-10-15","2021-10-15","2021-10-15","2021-10-15","2021-10-15","2021-08-23","2021-08-23","2020-07-10","2020-07-10","2021-04-27","2021-08-23","2020-04-21","2020-04-21","2021-03-23","2020-11-18","2021-08-23","2021-08-23","2021-08-23","2021-08-23","2021-08-23","2021-08-23","2021-08-23","2021-08-17"],"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":[["","65162062750","TRAMADOL","50MG","20","Select","Select",""],["","65862001005","METFORMIN","1000MG","60","Select","Select",""],["","00832532515","POT CL MICRO","20MEQ ER","30","Select","Select",""],["","55111012701","CIPROFLOXACN","500MG","14","Select","Select",""],["","00143980350","DOXYCYCL","100MG","20","Select","Select",""],["","57237000201","HYDROCHLOROT","12.5MG","30","Select","Select",""],["","58160088552","FLUARIX","2020-21","0","Select","Select",""],["","57237007810","ONDANSETRON","8MG ODT","20","Select","Select",""],["","69315011710","FUROSEMIDE","40MG","30","Select","Select",""],["","70377002811","ATORVASTATIN","20MG","30","Select","Select",""],["","13811071910","NITROFURANTN","100MG","14","Select","Select",""],["","55111046605","METOPROL","25MG ER","30","Select","Select",""],["","00245531915","KLOR-CON","20MEQ ER","30","Select","Select",""],["","65862042005","SMZ\/TMP","800-160","14","Select","Select",""],["","68180051303","LISINOPRIL","5MG","30","Select","Select",""],["","65162062750","TRAMADOL ","TAB 50MG","20","Select","Select",""],["","65862001005","METFORMIN ","TAB 1000MG","60","Select","Select",""],["","00143980350","DOXYCYCL ","CAP 100MG","20","Select","Select",""],["","55111012701","CIPROFLOXACN ","TAB 500MG","14","Select","Select",""],["","00832532515","POT  CL MICRO","TAB 20MEQ ER","30","Select","Select",""],["","58160088552","FLUARIX ","INJ 2020-21","0","Select","Select",""],["","13811071910","NITROFURANTN ","CAP 100MG","14","Select","Select",""],["","57237000201","HYDROCHLOROT ","CAP 12.5MG","30","Select","Select",""],["","57237007810","ONDANSETRON ","TAB 8MG ODT","20","Select","Select",""],["","65862042005","SMZ\/TMP ","TAB 800-160","14","Select","Select",""],["","00245531915","KLOR-CON ","TAB 20MEQ ER","30","Select","Select",""],["","55111046605","METOPROL ","TAB 25MG ER","30","Select","Select",""],["","70377002811","ATORVASTATIN ","TAB 20MG","30","Select","Select",""],["","69315011710","FUROSEMIDE ","TAB 40MG","30","Select","Select",""],["","68180051303","LISINOPRIL ","TAB 5MG","30","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":""}]}]}