{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JENNIFER   LYNN PODISH","gend":1,"add":"4871 HICKORY SIGNPOST ROAD","city":"WILLIAMSBURG","state":"VA","zip":"23185-9998","dob":"1971-11-19","age":"","mstatus":"","insh":"2037511*01","cliId":"","pno":"757\/876-6247","cno":"757\/258-0013","email":"","ename":"","eno":"","pphy":"MUENCH, DANIEL M MD","ppno":"757\/345-2555","pcpadd":"120 KINGS WAY SUITE 1400","pcpcity":"WILLIAMSBURG","pcpstate":"VA","pcpzip":23185,"pcpcounty":"","pcpid":118380,"pcpname":"Riverside Williamsburg Family Medicine","plan":"OHP","program":"ACA","lob":"Individual","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/345-0366","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["D86.9","L60.3","B07.0","B35.1","E78.5","E80.6","R31.9","R73.01","Z68.24","I10.","R07.89","D86.0","Z01.419","L92.9","N92.3","Z11.51","L81.4","D18.01","D48.5","Z00.00"],"date":["2021-08-26","2021-04-15","2021-04-15","2021-04-15","2020-10-16","2020-10-16","2020-10-16","2020-10-16","2020-03-05","2020-10-16","2020-12-04","2020-11-05","2021-02-19","2020-01-24","2020-01-24","2021-02-19","2020-02-27","2020-02-27","2020-02-27","2021-10-29"],"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":[["","68462053670","IMIQUIMOD","5%","30","Select","Select",""],["","00093321992","KETOCONAZOLE","2%","60","Select","Select",""],["","68462053670","IMIQUIMOD ","5%","30","Select","Select",""],["","00093321992","KETOCONAZOLE ","2%","30","Select","Select",""],["","00173068220","VENTOLIN","","18","Select","Select",""],["","69097014260","ALBUTEROL","HFA","7","Select","Select",""],["","00085113204","PROVENTIL","HFA","7","Select","Select",""],["","00173068220","VENTOLIN ","AER ","18","Select","Select",""],["","69097014260","ALBUTEROL ","AER HFA","7","Select","Select",""],["","70377000612","ROSUVASTATIN ","TAB 5MG","30","Select","Select",""],["","00085113204","PROVENTIL ","AER HFA","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":""}]}]}