{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LAURA   JILL DIGGS","gend":1,"add":"4420 EAGLEBROOK DR","city":"WILLIAMSBURG","state":"VA","zip":"23188-9998","dob":"1960-11-10","age":"","mstatus":"","insh":"2002201*01","cliId":"","pno":"757\/968-3253","cno":"757\/968-3253","email":"","ename":"","eno":"","pphy":"SUBRAMANIAM, SARITA G MD","ppno":"757\/659-6286","pcpadd":"4125 IRONBOUND ROAD SUITE 203","pcpcity":"WILLIAMSBURG","pcpstate":"VA","pcpzip":23188,"pcpcounty":"","pcpid":165984,"pcpname":"","plan":"OHP","program":"ACA","lob":"Individual","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":["R20.2","E78.2","E03.9","C44.619","G24.3","G25.0","F41.9","H40.033","H10.423","H04.123","H25.13","M54.2","M54.16","Z23.","H10.13","F41.1","Z01.419","M25.50","E55.9","E53.8","S33.6XXD","M47.896","M54.6","F32.0","Z79.899","Z12.31","M51.36","Z68.24","F17.210","D48.5","L30.9","L29.9","L82.1","D18.01","Z71.9","N95.1","M85.89"],"date":["2021-03-16","2021-09-14","2021-09-14","2020-01-24","2021-09-14","2021-09-14","2020-09-21","2021-07-12","2020-12-28","2021-07-12","2021-07-12","2021-07-08","2021-07-08","2021-09-28","2021-07-12","2021-09-14","2020-07-31","2021-09-07","2021-03-16","2021-03-16","2020-06-11","2021-11-01","2020-06-11","2021-09-14","2021-09-07","2021-03-16","2021-09-14","2020-11-17","2021-09-14","2020-01-24","2020-01-24","2020-01-24","2020-01-24","2020-01-24","2020-01-24","2020-07-31","2021-11-01"],"priorHcc":["","","","","","","","","","","","","",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":[["","00555089902","ESTRADIOL","0.5MG","30","Select","Select",""],["","00023916360","RESTASIS","0.05%","180","Select","Select",""],["","59651005290","EZETIMIBE","10MG","30","Select","Select",""],["","00093321205","CLONAZEPAM","1MG","60","Select","Select",""],["","50428034819","CAPSAICIN","0.10%","42","Select","Select",""],["","00378180510","LEVOTHYROXIN","75MCG","30","Select","Select",""],["","51991074790","DULOXETINE","30MG","-30","Select","Select",""],["","51672300302","HYDROCORT","2.50%","28","Select","Select",""],["","60505057501","OLOPATADINE","0.10%","5","Select","Select",""],["","69097081312","GABAPENTIN","100MG","-90","Select","Select",""],["","16729020001","BUSPIRONE","5MG","-90","Select","Select",""],["","51672412301","CARBAMAZEPIN","100MGER","60","Select","Select",""],["","49281042050","FLUZONE","2020-21","0","Select","Select",""],["","00093321205","CLONAZEPAM ","1MG","60","Select","Select",""],["","00555089902","ESTRADIOL ","0.5MG","30","Select","Select",""],["","51672300302","HYDROCORT ","2.50%","28","Select","Select",""],["","00378180510","LEVOTHYROXIN ","75MCG","30","Select","Select",""],["","50428034819","CAPSAICIN ","0.10%","42","Select","Select",""],["","59651005290","EZETIMIBE ","10MG","30","Select","Select",""],["","00023916360","RESTASIS ","0.05%","180","Select","Select",""],["","60505057501","OLOPATADINE ","0.10%","5","Select","Select",""],["","69097081312","GABAPENTIN ","100MG","90","Select","Select",""],["","51991074790","DULOXETINE ","30MG","30","Select","Select",""],["","49281042050","FLUZONE ","2020-21","0","Select","Select",""],["","51672412301","CARBAMAZEPIN ","100MGER","60","Select","Select",""],["","16729020001","BUSPIRONE ","5MG","90","Select","Select",""],["","19515081852","FLULAVAL","2021-22","0","Select","Select",""],["","19515081852","FLULAVAL ","INJ 2021-22","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":""}]}]}