{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BROOKE MILLER","gend":1,"add":"1632 MATHEWS TERRACE","city":"PORTSMOUTH","state":"VA","zip":"23704-9998","dob":"1979-06-28","age":"","mstatus":"","insh":"1795646*02","cliId":"","pno":"703\/851-0833","cno":"703\/851-0833","email":"","ename":"","eno":"","pphy":"LAYNE, MICHAEL MD","ppno":"757\/446-5955","pcpadd":"825 FAIRFAX AVE SUITE 118","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23507,"pcpcounty":"","pcpid":100070,"pcpname":"EVMS Ghent Family Medicine","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"207\/266-4069","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/446-5196","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J06.9","B97.89","N93.9","F31.9","N18.3","Z79.899","Z88.8","Q60.1","N14.1","R94.4","N94.6","I10.","E03.9","R10.2","G89.29","R63.5","N18.9","N26.1","N28.9","N28.1","N92.6","R19.8","N18.32","Q60.2","K52.9","F43.0","E87.5","Z20.828"],"date":["2020-03-05","2020-03-05","2020-03-05","2020-03-05","2020-08-19","2020-03-05","2020-03-05","2021-01-13","2020-08-19","2020-08-19","2020-01-30","2020-01-30","2020-01-31","2020-02-19","2020-01-31","2020-01-31","2020-01-31","2020-02-19","2020-02-19","2020-02-19","2020-03-09","2020-02-24","2021-01-13","2021-01-13","2021-08-22","2021-08-22","2021-08-22","2021-08-22"],"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":[["","00527134210","LEVOTHYROXIN","50MCG","115","Select","Select",""],["","55111053405","DIVALPROEX","500MG ER","360","Select","Select",""],["","00378711277","OLMESA","20MG","30","Select","Select",""],["","60505313001","QUETIAPINE","25MG","90","Select","Select",""],["","52544024828","TRINESSA","","-28","Select","Select",""],["","68462015713","ONDANSETRON","4MG ODT","12","Select","Select",""],["","51224001060","BENZONATATE","100MG","29","Select","Select",""],["","49281072010","FLUBLOK","2020-21","0","Select","Select",""],["","00527134210","LEVOTHYROXIN ","50MCG","115","Select","Select",""],["","55111053405","DIVALPROEX ","500MG ER","360","Select","Select",""],["","00378711277","OLMESA ","20MG","30","Select","Select",""],["","68462015713","ONDANSETRON ","4MG ODT","12","Select","Select",""],["","51224001060","BENZONATATE ","100MG","29","Select","Select",""],["","60505313001","QUETIAPINE ","25MG","90","Select","Select",""],["","52544024828","TRINESSA ","","28","Select","Select",""],["","49281072010","FLUBLOK ","2020-21","0","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":""}]}]}