{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"AMY   E MORRISSEY","gend":1,"add":"2548 LAKEWOOD LN","city":"CHESAPEAKE","state":"VA","zip":"23321-9998","dob":"1975-07-01","pno":"757\/576-2504","cno":"757\/576-2504","email":"","pphy":"","ppno":"","pcpadd":"","pcpcity":"","pcpstate":"","pcpzip":"","pcpcounty":"","pcpid":"","pcpname":"","insh":"1874840*02","cliId":"","plan":"OHP","program":"ACA","lob":"Individual","region":"TIDEWATER","aligned":"","ano":"757\/576-2504","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":["R63.1","E55.9","E66.01","I10.","R25.3","R51.9","G50.1","M54.42","R32.","M54.6","G40.909","M54.41","M51.17","M51.16","R23.2","N17.9","M51.24","M47.26","M47.816","M47.817","R00.2","M62.838","R21.","G40.89","R19.7","R11.2","R14.0","Z53.21","Z80.0","E28.2","K52.9","G89.29","N61.0","N64.59","Z76.0","R07.9","R55.","N63.20","R92.8","G44.89","R53.1","R56.9","G47.33","Z13.9","M54.9","M54.30"],"date":["2021-02-19","2021-10-28","2021-02-19","2021-10-28","2021-02-19","2021-04-21","2021-03-31","2021-03-31","2021-04-14","2021-03-31","2021-04-28","2021-04-14","2021-03-31","2021-03-31","2021-04-28","2021-05-05","2021-04-14","2021-04-14","2021-04-14","2021-04-14","2021-07-22","2021-07-22","2021-07-22","2020-01-31","2020-06-09","2020-06-09","2020-06-09","2021-01-18","2021-02-09","2021-02-09","2021-02-09","2021-02-09","2021-09-13","2020-03-13","2020-10-29","2021-01-18","2021-01-18","2020-03-18","2020-03-18","2021-01-21","2021-01-21","2021-01-21","2020-06-23","2020-06-23","2021-10-28","2021-10-28"],"priorHcc":["",null,"",null,"","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",null,null]}},{"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":[["","00093078701","ATENOLOL","25MG","30","Select","Select",""],["","69097012503","TOPIRAMATE","200MG","30","Select","Select",""],["","00832059011","DIPHEN\/ATROP","","-120","Select","Select",""],["","68382004101","PROMETHAZINE","25MG","60","Select","Select",""],["","65862039010","ONDANSETRON","4MG ODT","-60","Select","Select",""],["","16729013616","CLONAZEPAM","0.5MG","20","Select","Select",""],["","67877019905","AMLODIPINE","10MG","90","Select","Select",""],["","65862062590","RIZATRIPTAN","5MG ODT","12","Select","Select",""],["","68462040601","INDOMETHACIN","25MG","104","Select","Select",""],["","13668027101","CARBAMAZEPIN","100MG","-180","Select","Select",""],["","00093310953","AMOXICILLIN","500MG","28","Select","Select",""],["","52817031910","BACLOFEN","5MG","30","Select","Select",""],["","64380073706","VITAMIN","50000UNT","12","Select","Select",""],["","59267100002","PFIZER","COVID-19","0","Select","Select",""],["","00591352530","LIDOCAINE","5%","30","Select","Select",""],["","65162083366","DICLOFENAC","1%","100","Select","Select",""],["","69238110005","DOXYCYCL","100MG","20","Select","Select",""],["","00093078701","ATENOLOL ","TAB 25MG","30","Select","Select",""],["","69097012503","TOPIRAMATE ","TAB 200MG","30","Select","Select",""],["","00832059011","DIPHEN\/ATROP ","TAB ","120","Select","Select",""],["","16729013616","CLONAZEPAM ","TAB 0.5MG","20","Select","Select",""],["","65862039010","ONDANSETRON ","TAB 4MG ODT","-60","Select","Select",""],["","68382004101","PROMETHAZINE ","TAB 25MG","60","Select","Select",""],["","68462040601","INDOMETHACIN ","CAP 25MG","180","Select","Select",""],["","67877019805","AMLODIPINE ","TAB 5MG","30","Select","Select",""],["","65862062590","RIZATRIPTAN ","TAB 5MG ODT","15","Select","Select",""],["","52817031910","BACLOFEN ","TAB 5MG","30","Select","Select",""],["","13668027101","CARBAMAZEPIN ","CHW 100MG","180","Select","Select",""],["","64380073706","VITAMIN ","CAP 50000UNT","12","Select","Select",""],["","00093310953","AMOXICILLIN ","CAP 500MG","28","Select","Select",""],["","00591352530","LIDOCAINE ","PAD 0.05","-30","Select","Select",""],["","69238110005","DOXYCYCL ","CAP 100MG","20","Select","Select",""],["","65162083366","DICLOFENAC ","GEL 0.01","100","Select","Select",""],["","59267100002","PFIZER ","INJ COVID-19","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":""}]}]}