{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LATOSHA   S ALLEN","gend":1,"add":"841 ISHAM PL","city":"NEWPORT NEWS","state":"VA","zip":"23608-9998","dob":"1985-09-24","age":"","mstatus":"","insh":"1914637*01","cliId":"","pno":"615\/542-9636","cno":"615\/542-9636","email":"","ename":"","eno":"","pphy":"SCHNEIDER, LINDA G MD","ppno":"757\/223-4992","pcpadd":"SUITE 5D 2115 EXECUTIVE DRIVE","pcpcity":"HAMPTON","pcpstate":"VA","pcpzip":23666,"pcpcounty":"","pcpid":119354,"pcpname":"HAMPTON FAMILY MEDICINE","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/223-5350","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["L65.9","L89.899","Z01.419","Z11.3","Z30.431","Z12.31","N63.21","R03.0","Z76.89","Z13.220","E66.01","Z72.0","Z13.6","Z68.43","Z00.00","R73.03","R63.4","I10."],"date":["2020-03-19","2020-03-19","2021-10-08","2021-10-08","2021-10-08","2020-11-16","2021-01-21","2021-09-27","2021-09-27","2021-09-27","2021-11-15","2021-09-27","2021-09-27","2021-11-15","2021-11-15","2021-11-15","2021-11-15","2021-11-15"],"priorHcc":["","",null,null,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":[["","52565002559","FLUOCINONIDE ","0.05%","-60","Select","Select",""],["","00093101042","MUPIROCIN ","2%","22","Select","Select",""],["","00143980305","DOXYCYCL ","100MG","-28","Select","Select",""],["","52565002559","FLUOCINONIDE","0.05%","-60","Select","Select",""],["","00143980305","DOXYCYCL","100MG","28","Select","Select",""],["","00093101042","MUPIROCIN","2%","22","Select","Select",""],["","29300012810","HYDROCHLOROT ","TAB 25MG","-90","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":""}]}]}