{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"VIVIANE   V NUNEZ","gend":1,"add":"2608 MECKLEY CT","city":"VIRGINIA BEACH","state":"VA","zip":"23454-9998","dob":"1981-03-02","pno":"978\/328-3232","cno":"978\/328-3232","email":"","pphy":"","ppno":"","pcpadd":"","pcpcity":"","pcpstate":"","pcpzip":"","pcpcounty":"","pcpid":"","pcpname":"","insh":"2007764*01","cliId":"","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":["F43.20","F41.0","E03.9","E78.00","G47.33","E89.0","R00.2","I44.1","F43.23","N64.4","R91.8","Z72.0","R20.0","R20.2","R10.13","R14.0","R93.2","R16.0","N28.1","R30.9","R39.15","R35.0","L29.2","R87.89","Z00.00","F41.9","N60.11","Z12.4","R05.","J02.9","R63.5","Z20.828","Z01.419","Z90.710","R68.82","Z20.822","L03.221"],"date":["2020-11-18","2020-11-18","2021-11-18","2021-11-18","2021-11-12","2020-09-23","2021-11-18","2021-11-18","2021-11-04","2021-01-07","2021-04-15","2021-11-18","2021-04-15","2021-04-15","2021-05-26","2021-05-26","2021-05-26","2021-05-26","2021-05-26","2021-06-25","2021-06-25","2021-06-25","2021-06-25","2021-06-25","2020-05-27","2020-05-27","2021-01-07","2021-02-23","2020-12-08","2020-12-08","2021-05-19","2021-03-29","2021-02-23","2021-02-23","2021-02-23","2021-03-29","2020-07-07"],"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":[["","16714035201","FLUOXETINE","20MG","-30","Select","Select",""],["","00555904758","ENPRESSE-28","","28","Select","Select",""],["","00781518592","LEVOTHYROXIN","112MCG","30","Select","Select",""],["","00603548221","PROPRANOLOL","10MG","60","Select","Select",""],["","00173068220","VENTOLIN","","18","Select","Select",""],["","66993001968","ALBUTEROL","HFA","18","Select","Select",""],["","72305011230","EUTHYROX","112MCG","30","Select","Select",""],["","00093005301","BUSPIRONE","5MG","60","Select","Select",""],["","55111014512","FLUCONAZOLE","150MG","2","Select","Select",""],["","51672138602","FLUOCINONIDE","0.05%","30","Select","Select",""],["","00143314250","DOXYCYCL","100MG","14","Select","Select",""],["","65862052730","VENLAFAXINE","37.5 ER","30","Select","Select",""],["","59267100001","PFIZER","COVID-19","0","Select","Select",""],["","65162047810","NITROFURANTN","100MG","14","Select","Select",""],["","00456045901","ARMOUR","60MG","30","Select","Select",""],["","16714035201","FLUOXETINE ","CAP 20MG","30","Select","Select",""],["","00603548221","PROPRANOLOL ","TAB 10MG","30","Select","Select",""],["","00781518592","LEVOTHYROXIN ","TAB 112MCG","30","Select","Select",""],["","00555904758","ENPRESSE-28 ","TAB ","28","Select","Select",""],["","66993001968","ALBUTEROL ","AER HFA","18","Select","Select",""],["","00173068220","VENTOLIN ","AER ","18","Select","Select",""],["","72305011230","EUTHYROX ","TAB 112MCG","30","Select","Select",""],["","00093005301","BUSPIRONE ","TAB 5MG","60","Select","Select",""],["","00093026292","FLUOCINONIDE ","CRE 0.0005","-30","Select","Select",""],["","00143314250","DOXYCYCL ","CAP 100MG","14","Select","Select",""],["","65862052730","VENLAFAXINE ","CAP 37.5 ER","-30","Select","Select",""],["","55111014512","FLUCONAZOLE ","TAB 150MG","2","Select","Select",""],["","59267100001","PFIZER ","INJ COVID-19","0","Select","Select",""],["","65162047810","NITROFURANTN ","CAP 100MG","14","Select","Select",""],["","00456045901","ARMOUR ","TAB 60MG","30","Select","Select",""],["","42192032701","NP ","TAB 15MG","30","Select","Select",""],["","50242087701","XOFLUZA ","TAB 80MG","1","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":[[["Yes","Select","","","","","Select","",""],["Yes","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":""}]}]}