{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ERICA   S SCHWEERS","gend":1,"add":"932 B OKLAHOMA DR CHESAPEAKE VA 23323","city":"CHESAPEAKE","state":"VA","zip":"23323-9998","dob":"1976-03-06","age":"","mstatus":"","insh":"1793494*01","cliId":"","pno":"757\/353-2058","cno":"757\/353-2058","email":"","ename":"","eno":"","pphy":"LIGHT, RYAN E MD","ppno":"757\/389-5370","pcpadd":"STE 100 1100 VOLVO PKWY","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":23320,"pcpcounty":"","pcpid":170690,"pcpname":"GREENBRIER FAMILY MEDICINE","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"757\/461-3400","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/389-5381","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["L30.9","N92.0","B37.3","M79.676","Z00.00","Z68.27","Z12.4","Z01.419","Z12.39","Z12.12","N73.6","D25.9","N80.0","Z01.818","Z78.9","N76.0","Z20.828","N94.6","N94.10"],"date":["2020-11-05","2021-02-15","2020-11-11","2020-11-05","2020-11-05","2020-11-05","2020-11-11","2020-11-11","2020-11-11","2020-11-11","2021-02-11","2021-02-11","2021-02-11","2021-01-19","2021-01-19","2021-01-19","2021-01-20","2020-12-08","2020-12-08"],"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":[["","55111014512","FLUCONAZOLE ","150MG","1","Select","Select",""],["","65862018601","CLINDAMYCIN ","300MG","28","Select","Select",""],["","65162047810","NITROFURANTN ","100MG","10","Select","Select",""],["","45802013970","METRONIDAZOL ","0.75%VAG","70","Select","Select",""],["","00904645780","DOK ","100MG","30","Select","Select",""],["","00406012301","HYDROCO\/APAP ","5-325MG","30","Select","Select",""],["","65162046650","IBUPROFEN ","800MG","60","Select","Select",""],["","65862018730","ONDANSETRON ","4MG","-30","Select","Select",""],["","16714066202","GABAPENTIN ","300MG","42","Select","Select",""],["","55111014512","FLUCONAZOLE","150MG","-1","Select","Select",""],["","65862018601","CLINDAMYCIN","300MG","28","Select","Select",""],["","65162047810","NITROFURANTN","100MG","10","Select","Select",""],["","45802013970","METRONIDAZOL","0.75%VAG","70","Select","Select",""],["","65162046650","IBUPROFEN","800MG","60","Select","Select",""],["","16714066202","GABAPENTIN","300MG","-42","Select","Select",""],["","65862018730","ONDANSETRON","4MG","-30","Select","Select",""],["","00406012301","HYDROCO\/APAP","5-325MG","30","Select","Select",""],["","00904645780","DOK","100MG","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":[[["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":""}]}]}