{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ELIZABETH RICHARDS","gend":1,"add":"7415 HUGHART ST","city":"NORFOLK","state":"VA","zip":"23505-9998","dob":"1983-02-09","age":"","mstatus":"","insh":"2009392*01","cliId":"","pno":"631\/988-9720","cno":"631\/988-9720","email":"","ename":"","eno":"","pphy":"LIGHT, RYAN E MD","ppno":"757\/389-5370","pcpadd":"STE 100 1100 VOLVO PKWY","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":23320,"pcpcounty":"","pcpid":170690,"pcpname":"GREENBRIER FAMILY MEDICINE","plan":"OHP","program":"ACA","lob":"Individual","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/389-5381","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F43.22","R30.0","Z68.32","K50.90","B37.3","Z11.3","Z12.31","F41.1","L73.2","L92.9","Z68.31","Z23.","N34.1","F41.9","Z20.828","E03.9","N30.01","N60.11","D24.2","N63.25","N63.13","R92.8","R92.2","F43.21","N60.12"],"date":["2021-06-22","2021-02-24","2021-02-12","2021-09-13","2021-05-19","2021-02-12","2021-06-09","2020-04-23","2020-01-06","2020-01-06","2021-03-11","2021-04-05","2021-03-11","2021-04-13","2020-11-09","2021-09-20","2020-12-20","2021-06-24","2021-06-24","2021-06-24","2021-06-24","2021-06-17","2021-06-17","2021-11-23","2021-06-24"],"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":[["","69238183301","LEVOTHYROXIN","88MCG","30","Select","Select",""],["","00472037915","CLOTRIM\/BETA","DIPROP","30","Select","Select",""],["","59762374301","CLINDAMYCIN","1%","30","Select","Select",""],["","00185012201","NITROFURANTN","100MG","10","Select","Select",""],["","57237000511","FLUCONAZOLE","150MG","2","Select","Select",""],["","00406012305","HYDROCO\/APAP","5-325MG","6","Select","Select",""],["","53489012002","DOXYCYCL","100MG","14","Select","Select",""],["","65862052790","VENLAFAXINE","37.5 ER","30","Select","Select",""],["","50111033402","METRONIDAZOL","500MG","-14","Select","Select",""],["","00116200116","CHLORHEX","0.12%","473","Select","Select",""],["","42192080201","PHENAZOPYRID","200MG","9","Select","Select",""],["","65862001705","AMOXICILLIN","500MG","21","Select","Select",""],["","64380080707","IBUPROFEN","800MG","30","Select","Select",""],["","00093317431","ALBUTEROL","HFA","8","Select","Select",""],["","00781808926","AZITHROMYCIN","250MG","6","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","69238183301","LEVOTHYROXIN ","88MCG","30","Select","Select",""],["","68462029817","CLOTRIM\/BETA ","DIPROP","-30","Select","Select",""],["","50111033402","METRONIDAZOL ","500MG","-14","Select","Select",""],["","13811071910","NITROFURANTN ","100MG","10","Select","Select",""],["","57237000511","FLUCONAZOLE ","150MG","2","Select","Select",""],["","59762374301","CLINDAMYCIN ","1%","30","Select","Select",""],["","00406012305","HYDROCO\/APAP ","5-325MG","6","Select","Select",""],["","42192080201","PHENAZOPYRID ","200MG","9","Select","Select",""],["","65862001705","AMOXICILLIN ","500MG","21","Select","Select",""],["","00116200116","CHLORHEX ","0.12%","473","Select","Select",""],["","64380080707","IBUPROFEN ","800MG","30","Select","Select",""],["","00781808926","AZITHROMYCIN ","250MG","6","Select","Select",""],["","53489012002","DOXYCYCL ","100MG","14","Select","Select",""],["","65862052790","VENLAFAXINE ","37.5 ER","30","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","00093317431","ALBUTEROL ","HFA","8","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","",""],["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":""}]}]}