{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ANNA KOZITSYNA","gend":1,"add":"3900 SHERMAN OAKS AVE","city":"VIRGINIA BEACH","state":"VA","zip":"23456-9998","dob":"1988-10-27","age":"","mstatus":"","insh":"1960655*01","cliId":"","pno":"757\/553-2102","cno":"757\/553-2102","email":"","ename":"","eno":"","pphy":"LI, WENHONG MD","ppno":"757\/689-8430","pcpadd":"SUITE 100 1925 GLENN MITCHELL DR","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23456,"pcpcounty":"","pcpid":141974,"pcpname":"Princess Anne Medical Associates","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"","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":["Z34.80","Z34.90","B18.1","R31.9","R82.79","D72.829","O36.80X0","Z36.87","Z12.4","Z36.2","Z00.00","O02.1","D64.9","O03.4","Z32.01","O34.219","Z86.19","Z3A.09","Z36.9","Z36.82","Z3A.13","O35.8XX0","Z36.86","Z3A.20","Z3A.22","R82.998","Z39.1","Z34.82","Z34.83","Z3A.32","R93.89","Z98.890","Z13.31","Z3A.36","Z36.85","Z36.89","Z01.812","Z01.818","O34.211","O98.42","Z37.0","O99.02","Z3A.39","Z79.899","Z38.01","O99.013","Z00.110","Z3A.38","Z3A.00","Z23.","Z3A.28","Z39.2","Z13.0","P03.4"],"date":["2021-02-19","2021-07-16","2021-08-11","2021-03-01","2021-07-29","2021-03-29","2021-01-13","2021-01-13","2021-01-13","2021-06-21","2020-02-05","2020-02-07","2021-06-21","2020-02-03","2021-01-13","2021-08-09","2021-05-24","2021-01-13","2021-06-21","2021-02-08","2021-02-08","2021-06-21","2021-03-29","2021-03-29","2021-04-12","2021-04-26","2021-05-20","2021-05-20","2021-05-20","2021-06-21","2021-06-21","2021-06-21","2021-09-21","2021-07-22","2021-07-22","2021-07-22","2021-08-09","2021-08-09","2021-08-11","2021-08-11","2021-08-11","2021-08-11","2021-08-11","2021-08-11","2021-08-12","2021-08-11","2021-08-17","2021-08-05","2021-08-09","2021-08-11","2021-05-24","2021-09-21","2021-09-21","2021-08-11"],"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":[["","59762500801","MISOPROSTOL","200MCG","8","Select","Select",""],["","42858010201","OXYCOD\/APAP","5-325MG","10","Select","Select",""],["","67877032105","IBUPROFEN","800MG","60","Select","Select",""],["","65862001401","AMOXICILLIN","500MG","15","Select","Select",""],["","00116200116","CHLORHEX","0.12%","473","Select","Select",""],["","59746000103","METHYLPRED","4MG","21","Select","Select",""],["","42192032130","PNV-DHA","","-30","Select","Select",""],["","59762500801","MISOPROSTOL ","200MCG","8","Select","Select",""],["","42858010201","OXYCOD\/APAP ","5-325MG","10","Select","Select",""],["","67877032105","IBUPROFEN ","800MG","60","Select","Select",""],["","65862001401","AMOXICILLIN ","500MG","15","Select","Select",""],["","59746000103","METHYLPRED ","4MG","21","Select","Select",""],["","00116200116","CHLORHEX ","0.12%","473","Select","Select",""],["","42192032130","PNV-DHA ","","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":""}]}]}