{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ELIZABETH GAMBLE","gend":1,"add":"1384 DALSBURY LN","city":"VIRGINIA BEACH","state":"VA","zip":"23456-9998","dob":"1960-02-14","age":"","mstatus":"","insh":"2016609*01","cliId":"","pno":"757\/651-3103","cno":"757\/651-3103","email":"","ename":"","eno":"","pphy":"CHOU, KEVIN MD","ppno":"757\/686-3515","pcpadd":"2088 S INDEPENDENCE BLVD","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23453,"pcpcounty":"","pcpid":172075,"pcpname":"Nowcare Princess Anne","plan":"OHP","program":"ACA","lob":"Individual","region":"TIDEWATER","aligned":"","ano":"757\/651-5416","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/686-0230","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z12.31","N64.89","M81.0","Z79.899","R22.1","E03.4","E04.1","R92.8","Z00.00","M79.672","E78.2","D64.9","H25.13","Z12.4","M79.605","I82.409","Z13.820","Z78.0","Z23.","N39.0","Z12.11","K57.30","K63.89","M85.89","L82.0","D18.01","L81.8","D22.5","E55.9","E03.9","G47.00","M25.562","Z01.419","Z71.89","R30.0","M79.671","E04.2","Z12.39","Z68.20","H40.013","H18.893","L90.5"],"date":["2021-02-04","2020-01-31","2021-08-13","2021-08-13","2021-03-11","2021-03-11","2021-03-09","2020-01-31","2020-11-10","2020-11-10","2020-11-10","2020-11-10","2020-11-30","2021-04-27","2020-02-26","2020-02-26","2020-10-22","2020-10-22","2021-02-19","2020-05-16","2020-09-18","2020-09-18","2020-09-18","2020-10-22","2020-11-23","2020-11-23","2020-11-23","2021-11-11","2021-09-02","2021-07-13","2020-11-17","2020-02-26","2021-04-27","2020-03-24","2021-06-14","2021-02-12","2021-07-13","2021-04-27","2021-06-30","2021-10-11","2021-10-11","2021-11-11"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}},{"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":[["","00781518192","LEVOTHYROXIN","50MCG","30","Select","Select",""],["","00378808345","TRETINOIN","0.05%","45","Select","Select",""],["","72305005030","EUTHYROX","50MCG","90","Select","Select",""],["","08290320550","BD PEN NEEDL","32GX5\/32","100","Select","Select",""],["","00002840001","FORTEO","600\/2.4","2","Select","Select",""],["","49281072010","FLUBLOK","2020-21","0","Select","Select",""],["","00228202950","ALPRAZOLAM","0.5MG","12","Select","Select",""],["","65162047810","NITROFURANTN","100MG","14","Select","Select",""],["","51293081001","PHENAZOPYRID","100MG","12","Select","Select",""],["","00781518192","LEVOTHYROXIN ","50MCG","30","Select","Select",""],["","00574220520","TRETINOIN ","0.05%","20","Select","Select",""],["","51293081001","PHENAZOPYRID ","100MG","12","Select","Select",""],["","65162047810","NITROFURANTN ","100MG","14","Select","Select",""],["","72305005030","EUTHYROX ","50MCG","90","Select","Select",""],["","49281072010","FLUBLOK ","2020-21","0","Select","Select",""],["","00002840001","FORTEO ","600\/2.4","2","Select","Select",""],["","08290320550","BD  PEN NEEDL","32GX5\/32","100","Select","Select",""],["","00228202950","ALPRAZOLAM ","0.5MG","12","Select","Select",""],["","68645051054","HYDROCHLOROT ","25MG","30","Select","Select",""],["","68645051054","HYDROCHLOROT","25MG","30","Select","Select",""],["","49281042150","FLUZONE","2021-22","0","Select","Select",""],["","80777027398","MODERNA","COVID-19","0","Select","Select",""],["","49281042150","FLUZONE ","INJ 2021-22","0","Select","Select",""],["","80777027398","MODERNA ","INJ COVID-19","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":""}]}]}