{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TAYLOR   HUFFMAN COGHILL","gend":1,"add":"465 HOLBROOK ROAD","city":"VIRGINIA BEACH","state":"VA","zip":"23452-9998","dob":"1991-01-03","age":"","mstatus":"","insh":"2035930*01","cliId":"","pno":"757\/769-6879","cno":"757\/769-6879","email":"","ename":"","eno":"","pphy":"SAMUELS, GARFIELD HUE MD","ppno":"757\/518-8823","pcpadd":"4452 CORPORATION LN STE 300","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23462,"pcpcounty":"","pcpid":148049,"pcpname":"","plan":"OHP","program":"ACA","lob":"Individual","region":"TIDEWATER","aligned":"","ano":"","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":["M79.7","K58.1","F32.2","N76.0","F33.9","G43.009","Z00.00","R87.610","R03.0","R51.","F41.9","K21.9","Z30.9","M41.9","G43.711","N87.1","B97.7","R87.612","Z32.02","R87.619","N93.9","Z12.4","Z79.3","H61.22","N87.0","Z98.890","F33.2"],"date":["2021-07-12","2020-04-07","2020-04-07","2020-10-27","2020-12-28","2021-04-05","2021-05-10","2021-03-31","2020-01-14","2020-01-14","2021-01-27","2021-01-27","2020-01-14","2021-07-12","2020-09-28","2021-07-12","2021-05-17","2021-03-29","2020-03-06","2021-01-29","2020-03-20","2020-01-14","2021-01-27","2021-03-07","2021-05-10","2021-07-12","2021-08-17"],"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":[["","00456150055","SAVELLA","TITR PAK","55","Select","Select",""],["","72205001390","PREGABALIN","75MG","60","Select","Select",""],["","69315090401","LORAZEPAM","0.5MG","90","Select","Select",""],["","00603254421","BUT\/APAP\/CAF","","30","Select","Select",""],["","00456120230","LINZESS","290MCG","30","Select","Select",""],["","55111015930","OMEPRAZOLE","40MG","-30","Select","Select",""],["","00904642661","ESCITALOPRAM","10MG","30","Select","Select",""],["","68382005105","MELOXICAM","15MG","30","Select","Select",""],["","57237001830","DULOXETINE","30MG","7","Select","Select",""],["","29300011716","TOPIRAMATE","100MG","30","Select","Select",""],["","68462064693","ASHLYNA","","-91","Select","Select",""],["","49281042050","FLUZONE","2020-21","0","Select","Select",""],["","65862060230","MODAFINIL","200MG","30","Select","Select",""],["","49281072010","FLUBLOK","2020-21","0","Select","Select",""],["","45802013970","METRONIDAZOL","0.75%VAG","70","Select","Select",""],["","00172392670","DIAZEPAM","5MG","1","Select","Select",""],["","00456150055","SAVELLA ","TITR PAK","55","Select","Select",""],["","00456120230","LINZESS ","290MCG","30","Select","Select",""],["","57237001830","DULOXETINE ","30MG","7","Select","Select",""],["","55111015930","OMEPRAZOLE ","40MG","90","Select","Select",""],["","68382005105","MELOXICAM ","15MG","30","Select","Select",""],["","69315090401","LORAZEPAM ","0.5MG","-90","Select","Select",""],["","72205001390","PREGABALIN ","75MG","60","Select","Select",""],["","00603254421","BUT\/APAP\/CAF ","","30","Select","Select",""],["","00904642661","ESCITALOPRAM ","10MG","30","Select","Select",""],["","68462064693","ASHLYNA ","","91","Select","Select",""],["","29300011516","TOPIRAMATE ","25MG","42","Select","Select",""],["","49281042050","FLUZONE ","2020-21","0","Select","Select",""],["","45802013970","METRONIDAZOL ","0.75%VAG","70","Select","Select",""],["","49281072010","FLUBLOK ","2020-21","0","Select","Select",""],["","57237015530","MODAFINIL ","200MG","30","Select","Select",""],["","00172392670","DIAZEPAM ","5MG","1","Select","Select",""],["","70954008510","CHLORZOXAZON ","500MG","90","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":""}]}]}