{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CANDACE   M MITCHAM","gend":1,"add":"226 FAULK ROAD","city":"NORFOLK","state":"VA","zip":"23502-9998","dob":"1966-10-01","age":"","mstatus":"","insh":"2022159*01","cliId":"","pno":"954\/804-4069","cno":"954\/804-4069","email":"","ename":"","eno":"","pphy":"VAKILY, SIMIN MD","ppno":"757\/455-6368","pcpadd":"SUITE 225 6161 KEMPSVILLE CIR","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23502,"pcpcounty":"","pcpid":125660,"pcpname":"Nowcare Medical Associates","plan":"OHP","program":"ACA","lob":"Individual","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/455-6686","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z12.31","Z00.00","M25.572","Z82.49","Z12.11","R03.0","M54.2","F41.1","D72.819","E66.3","E78.00","M25.561","D75.89","L21.8","K13.0","L57.0","Z86.32","M54.5","S83.281A","S83.241A","M17.11","M25.461","G43.009","I10.","N95.1","Z20.828","M79.10","R43.0","R05.","R53.83","R51.9","R43.2","L82.1","M23.321","M23.351","R10.9","K57.30","G89.29","R14.0","R11.0","Z23.","R31.29","K59.00"],"date":["2021-05-07","2021-10-20","2020-11-06","2020-11-20","2020-11-19","2021-10-20","2021-03-02","2021-09-14","2021-03-02","2021-09-14","2021-10-20","2021-08-06","2020-11-06","2021-01-25","2021-01-25","2021-01-25","2020-06-08","2021-01-25","2020-06-30","2020-06-30","2021-06-11","2021-06-11","2020-06-08","2020-08-07","2021-10-20","2020-11-21","2020-11-07","2020-11-07","2020-11-07","2020-11-07","2020-11-07","2020-11-07","2020-01-24","2020-06-30","2020-06-30","2021-10-20","2021-08-30","2021-08-06","2021-08-30","2021-11-08","2021-10-20","2021-10-20","2021-10-20"],"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":[["","00168009930","KETOCONAZOLE ","2%","-30","Select","Select",""],["","69097052444","DICLOFENAC ","1%","100","Select","Select",""],["","57237000511","FLUCONAZOLE ","150MG","2","Select","Select",""],["","00168008915","NYSTAT\/TRIAM ","","15","Select","Select",""],["","00316022115","NYSTATIN ","100000","15","Select","Select",""],["","00378427677","VALACYCLOVIR ","1GM","-20","Select","Select",""],["","62756052269","SUMATRIPTAN ","100MG","9","Select","Select",""],["","59088016554","VITREXYL ","IRON","30","Select","Select",""],["","00781106110","ALPRAZOLAM ","0.25MG","30","Select","Select",""],["","52817033200","CYCLOBENZAPR ","10MG","15","Select","Select",""],["","00093321930","KETOCONAZOLE","2%","30","Select","Select",""],["","69097052444","DICLOFENAC","1%","100","Select","Select",""],["","00168008915","NYSTAT\/TRIAM","","15","Select","Select",""],["","57237000511","FLUCONAZOLE","150MG","2","Select","Select",""],["","62756052269","SUMATRIPTAN","100MG","9","Select","Select",""],["","00378427677","VALACYCLOVIR","1GM","20","Select","Select",""],["","00316022115","NYSTATIN","100000","15","Select","Select",""],["","59088016554","VITREXYL","IRON","30","Select","Select",""],["","52817033200","CYCLOBENZAPR","10MG","15","Select","Select",""],["","00781106110","ALPRAZOLAM","0.25MG","30","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":""}]}]}