{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TARI   LYNN CORRIGAN","gend":1,"add":"109 MONTCLIFF CT APT 101","city":"VIRGINIA BEACH","state":"VA","zip":"23452-9998","dob":"1965-12-26","age":"","mstatus":"","insh":"1878203*01","cliId":"","pno":"757\/748-2546","cno":"757\/748-2546","email":"","ename":"","eno":"","pphy":"ELHASSAN, AMIRA S MD","ppno":"757\/738-1300","pcpadd":"4421 VIRGINIA BEACH BLVD STE 114","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23462,"pcpcounty":"","pcpid":207903,"pcpname":"BON SECOURS MEDICAL ASSOCIATES","plan":"OHP","program":"ACA","lob":"Individual","region":"TIDEWATER","aligned":"","ano":"757\/748-2546","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/687-3202","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["D47.3","I10.","F41.9","F32.9","F90.9","H02.88A","H02.88B","D22.122","H04.121","H04.122","F98.8","Z00.00","Z23.","N39.0","C50.919","F90.2","R63.4","Z01.419","C50.912","Z17.1","C41.0","E28.39","R89.7"],"date":["2021-03-29","2021-10-11","2020-10-05","2021-10-11","2020-07-06","2020-01-06","2020-01-06","2020-01-06","2020-01-06","2020-01-06","2020-06-15","2021-10-11","2021-10-11","2020-10-05","2021-10-11","2021-04-15","2021-04-15","2020-10-05","2021-04-15","2021-04-15","2021-09-08","2021-10-11","2021-09-10"],"priorHcc":["",null,"",null,"","","","","","","",null,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":[["","31722070110","LOSARTAN","50MG","-30","Select","Select",""],["","00069046956","CHANTIX","1MG","60","Select","Select",""],["","65162024709","CHLORTHALID","25MG","30","Select","Select",""],["","65862020901","MINOCYCLINE","50MG","30","Select","Select",""],["","50111064801","FLUOXETINE","20MG","30","Select","Select",""],["","00228203150","ALPRAZOLAM","1MG","60","Select","Select",""],["","00574402435","ERYTHROMYCIN","5MG\/GM","-4","Select","Select",""],["","68180072103","AMLODIPINE","10MG","30","Select","Select",""],["","70461032003","FLUCLVX","2020-21","0","Select","Select",""],["","00185012201","NITROFURANTN","100MG","14","Select","Select",""],["","31722070110","LOSARTAN ","50MG","30","Select","Select",""],["","65162024709","CHLORTHALID ","25MG","30","Select","Select",""],["","00069046956","CHANTIX ","1MG","60","Select","Select",""],["","65862020901","MINOCYCLINE ","50MG","30","Select","Select",""],["","50111064801","FLUOXETINE ","20MG","30","Select","Select",""],["","00228203150","ALPRAZOLAM ","1MG","60","Select","Select",""],["","68180072103","AMLODIPINE ","10MG","30","Select","Select",""],["","00574402435","ERYTHROMYCIN ","5MG\/GM","4","Select","Select",""],["","00185012201","NITROFURANTN ","100MG","14","Select","Select",""],["","70461032003","FLUCLVX ","2020-21","0","Select","Select",""],["","00406012305","HYDROCO\/APAP ","5-325MG","6","Select","Select",""],["","64380080807","IBUPROFEN ","600MG","-30","Select","Select",""],["","65862001705","AMOXICILLIN ","500MG","15","Select","Select",""],["","64380080807","IBUPROFEN","600MG","-30","Select","Select",""],["","00406012305","HYDROCO\/APAP","5-325MG","-6","Select","Select",""],["","65862001705","AMOXICILLIN","500MG","15","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","",""],["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":""}]}]}