{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DONNA   P TUCKER","gend":1,"add":"26 W PRESTON ST","city":"HAMPTON","state":"VA","zip":"23669-9998","dob":"1965-10-04","age":"","mstatus":"","insh":"1970174*02","cliId":"","pno":"757\/722-6405","cno":"757\/722-6405","email":"","ename":"","eno":"","pphy":"BOYER, DEBRA MD","ppno":"757\/850-1311","pcpadd":"191 FOX HILL ROAD STE D","pcpcity":"HAMPTON","pcpstate":"VA","pcpzip":23669,"pcpcounty":"","pcpid":118380,"pcpname":"Elizabeth Lakes Family Practice","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"757\/725-3339","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/850-7315","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["B18.2","Z13.0","Z13.220","E55.9","Z23.","I49.8","F17.210","R00.0","Z12.11","R42.","R94.31","J45.901","Z71.6","F33.9","Z82.49"],"date":["2020-09-28","2020-09-28","2020-09-28","2020-09-28","2021-04-07","2020-10-08","2020-10-08","2020-11-19","2021-08-30","2020-09-30","2020-11-10","2020-09-28","2020-09-28","2020-09-28","2020-09-28"],"priorHcc":["","","","","","","","",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":[["","00591024105","LORAZEPAM","1MG","120","Select","Select",""],["","00173068220","VENTOLIN","","18","Select","Select",""],["","13668001001","CITALOPRAM","20MG","30","Select","Select",""],["","66993001968","ALBUTEROL","HFA","18","Select","Select",""],["","60505015801","BUPROPION","75MG","-60","Select","Select",""],["","00591024105","LORAZEPAM ","1MG","120","Select","Select",""],["","00173068220","VENTOLIN ","","18","Select","Select",""],["","00378623201","CITALOPRAM ","20MG","-30","Select","Select",""],["","66993001968","ALBUTEROL ","HFA","18","Select","Select",""],["","60505015801","BUPROPION ","75MG","-60","Select","Select",""],["","59267100001","PFIZER ","COVID-19","0","Select","Select",""],["","59267100001","PFIZER","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","",""],["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":""}]}]}