{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"AMPARO DANIELS","gend":1,"add":"533 BIRMINGHAM AVE","city":"NORFOLK","state":"VA","zip":"23505-9998","dob":"1959-03-24","age":"","mstatus":"","insh":"2008251*01","cliId":"","pno":"757\/440-8499","cno":"757\/440-8499","email":"","ename":"","eno":"","pphy":"HASAS, PEDRO D MD","ppno":"757\/583-4329","pcpadd":"STE 205 160 KINGSLEY LANE","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23505,"pcpcounty":"","pcpid":221172,"pcpname":"","plan":"OHP","program":"ACA","lob":"Individual","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/583-1770","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N39.0","R05.","Z03.818","Z11.59","R30.0","K76.0","R94.5","Z23.","M54.9","R94.6","N60.01","I10.","G60.9","N64.4","R10.84","M54.5","R35.0","E78.5","K21.9","Z13.31","M25.50","M65.312","K21.00","Z00.00","M25.69","E88.9","Z12.31","M79.18","R92.2","R92.8","M79.642","M79.641","M25.562","M85.841","M85.842","H25.13","H04.123","H52.03","H52.223","H52.4","J18.9","R06.02","R05.3"],"date":["2020-02-17","2020-02-17","2020-08-09","2020-08-09","2020-10-05","2021-04-19","2021-08-09","2020-10-05","2020-11-09","2020-11-09","2021-05-03","2021-08-09","2021-05-03","2020-02-17","2020-02-17","2020-02-17","2020-10-05","2021-08-09","2020-11-09","2020-10-05","2021-03-15","2021-02-15","2021-02-15","2020-01-24","2021-02-15","2021-02-15","2021-04-12","2020-11-09","2021-04-19","2021-04-28","2021-02-15","2021-02-15","2021-02-15","2021-02-15","2021-02-15","2021-09-04","2021-09-04","2021-09-04","2021-09-04","2021-09-04","2021-10-24","2021-10-24","2021-10-24"],"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":[["","60505257809","ATORVASTATIN","10MG","-30","Select","Select",""],["","65162062710","TRAMADOL","50MG","14","Select","Select",""],["","64380080303","RANITIDINE","150MG","90","Select","Select",""],["","65862018501","CLINDAMYCIN","150MG","40","Select","Select",""],["","31722072250","LEVOFLOXACIN","500MG","3","Select","Select",""],["","65862039010","ONDANSETRON","4MG ODT","8","Select","Select",""],["","68462010340","FLUCONAZOLE","150MG","1","Select","Select",""],["","00093310953","AMOXICILLIN","500MG","30","Select","Select",""],["","68180072003","AMLODIPINE","5MG","90","Select","Select",""],["","13668044101","CELECOXIB","100MG","7","Select","Select",""],["","00228282011","HYDROCHLOROT","12.5MG","30","Select","Select",""],["","59267100001","PFIZER","COVID-19","0","Select","Select",""],["","00054327099","FLUTICASONE","50MCG","16","Select","Select",""],["","64380071206","BENZONATATE","100MG","30","Select","Select",""],["","16714043901","NITROFURANTN","100MG","10","Select","Select",""],["","55111064505","OMEPRAZOLE","40MG","30","Select","Select",""],["","69097094312","GABAPENTIN","300MG","30","Select","Select",""],["","69097084615","CYCLOBENZAPR","10MG","20","Select","Select",""],["","60505257809","ATORVASTATIN ","10MG","30","Select","Select",""],["","65862039010","ONDANSETRON ","4MG ODT","8","Select","Select",""],["","64380080303","RANITIDINE ","150MG","30","Select","Select",""],["","31722072250","LEVOFLOXACIN ","500MG","3","Select","Select",""],["","65162062710","TRAMADOL ","50MG","14","Select","Select",""],["","64380071206","BENZONATATE ","100MG","30","Select","Select",""],["","16714043901","NITROFURANTN ","100MG","10","Select","Select",""],["","68462010340","FLUCONAZOLE ","150MG","1","Select","Select",""],["","65862018501","CLINDAMYCIN ","150MG","40","Select","Select",""],["","00093310953","AMOXICILLIN ","500MG","30","Select","Select",""],["","13668044101","CELECOXIB ","100MG","7","Select","Select",""],["","69097084615","CYCLOBENZAPR ","10MG","20","Select","Select",""],["","55111015810","OMEPRAZOLE ","20MG","90","Select","Select",""],["","68180072003","AMLODIPINE ","5MG","90","Select","Select",""],["","59267100001","PFIZER ","COVID-19","0","Select","Select",""],["","00228282011","HYDROCHLOROT ","12.5MG","30","Select","Select",""],["","69097081312","GABAPENTIN ","100MG","30","Select","Select",""],["","00054327099","FLUTICASONE ","50MCG","16","Select","Select",""],["","69238110005","DOXYCYCL","100MG","-20","Select","Select",""],["","08373747800","OPTICHAMBER","DIAMOND","1","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","00093317431","ALBUTEROL","HFA","8","Select","Select",""],["","69238110005","DOXYCYCL ","CAP 100MG","20","Select","Select",""],["","08373747800","OPTICHAMBER ","MIS DIAMOND","-1","Select","Select",""],["","55111073005","ALLOPURINOL ","TAB 300MG","30","Select","Select",""],["","59310057922","PROAIR ","AER ","8","Select","Select",""],["","00093317431","ALBUTEROL ","AER HFA","8","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":""}]}]}