{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ANN HENNINGS","gend":1,"add":"2012 COLORADO AVE","city":"PORTSMOUTH","state":"VA","zip":"23701-9998","dob":"1959-02-03","age":"","mstatus":"","insh":"2009687*01","cliId":"","pno":"757\/642-6705","cno":"757\/642-6705","email":"","ename":"","eno":"","pphy":"JONES, ERIC L MD","ppno":"757\/399-0759","pcpadd":"3315 HIGH ST","pcpcity":"PORTSMOUTH","pcpstate":"VA","pcpzip":23707,"pcpcounty":"","pcpid":162911,"pcpname":"","plan":"OHP","program":"ACA","lob":"Individual","region":"TIDEWATER","aligned":"","ano":"757\/642-6705","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":["R53.83","R06.83","M81.0","Z78.0","F32.9","D48.5","Z71.9","Z01.419","L28.0","M19.071","M25.571","M81.8","F17.200","L68.0","B35.1","Z12.2","Z87.891","J40.","J43.9","Z12.31","D75.1","Z23.","M79.674","Z20.822"],"date":["2021-07-09","2020-08-07","2020-09-28","2020-02-07","2021-11-10","2020-10-19","2020-10-19","2020-03-02","2020-10-19","2020-11-25","2021-07-09","2021-11-10","2021-11-10","2021-11-10","2021-11-10","2021-08-06","2021-08-06","2021-08-06","2021-08-06","2021-08-30","2021-11-10","2021-11-10","2021-11-10","2021-10-05"],"priorHcc":["","","","",null,"","","","","","",null,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":[["","00054327099","FLUTICASONE","50MCG","48","Select","Select",""],["","53746051101","SPIRONOLACT","25MG","30","Select","Select",""],["","45802046564","KETOCONAZOLE","2%","240","Select","Select",""],["","00299550004","CAPEX","0.01%","120","Select","Select",""],["","13668013701","ESCITALOPRAM","20MG","30","Select","Select",""],["","50383097904","CLOBETASOL","0.05%","118","Select","Select",""],["","53746051101","SPIRONOLACT ","25MG","90","Select","Select",""],["","00054327099","FLUTICASONE ","50MCG","16","Select","Select",""],["","13668013701","ESCITALOPRAM ","20MG","30","Select","Select",""],["","45802046564","KETOCONAZOLE ","2%","240","Select","Select",""],["","00299550004","CAPEX ","0.01%","120","Select","Select",""],["","00781713704","CLOBETASOL ","0.05%","118","Select","Select",""],["","69097073102","TERBINAFINE ","250MG","30","Select","Select",""],["","69097073102","TERBINAFINE","250MG","90","Select","Select",""],["","45802014167","CICLOPIROX ","SOL 0.08","-7","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":""}]}]}