{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ADRIENNE   D LINK","gend":1,"add":"3523 COLMAR QUARTER","city":"NORFOLK","state":"VA","zip":"23509-9998","dob":"1968-01-31","age":"","mstatus":"","insh":"2054549*02","cliId":"","pno":"804\/405-1628","cno":"804\/405-1628","email":"","ename":"","eno":"","pphy":"DAMMAN, JULIE L MD","ppno":"757\/252-9300","pcpadd":"STE 900 301 RIVERVIEW AVE","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23510,"pcpcounty":"","pcpid":161498,"pcpname":"SMG - Dedicated Care Center","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"757\/403-3928","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/510-9278","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["S61.204A","T79.8XXA","E53.8","E78.5","K21.9","D51.0","E55.9","Z00.00","R31.29","R00.2","R05.","M19.90","G62.9","J02.9","R09.81","R51.","R50.9","Z01.419","Z12.39","Z12.12","Z23.","F90.0","G44.89","H93.8X3","M79.601","N95.9","F41.1","R10.30","K42.9","Z90.710","R10.31","R53.81","R05.9","J06.9","K57.30","R10.32","Z11.59"],"date":["2020-01-08","2020-01-08","2021-10-13","2020-09-24","2021-10-13","2021-03-15","2021-09-28","2021-09-28","2021-10-13","2020-09-24","2020-09-24","2021-09-28","2020-09-24","2020-07-13","2020-03-19","2020-01-24","2020-01-24","2021-02-09","2021-02-09","2021-02-09","2020-09-24","2020-09-24","2020-03-19","2020-03-19","2021-04-16","2020-04-20","2020-04-20","2021-08-31","2021-08-31","2021-08-31","2021-10-15","2021-10-13","2021-10-13","2021-10-13","2021-10-15","2021-10-15","2021-09-28"],"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":[["","00093314705","CEPHALEXIN","500MG","14","Select","Select",""],["","00555097202","AMPHET\/DEXTR","10MG","60","Select","Select",""],["","65862001705","AMOXICILLIN","500MG","30","Select","Select",""],["","27808008601","HYD","10-8\/5ML","60","Select","Select",""],["","00173085910","BREO","100-25","-60","Select","Select",""],["","00378932032","WIXELA","100\/50","60","Select","Select",""],["","00173069500","ADVAIR","100\/50","60","Select","Select",""],["","00228203150","ALPRAZOLAM","1MG","30","Select","Select",""],["","00555088602","ESTRADIOL","1MG","90","Select","Select",""],["","62559015001","EST","MTEST HS","5","Select","Select",""],["","00406037605","HYDROCO\/APAP","5-300MG","12","Select","Select",""],["","29300012410","MELOXICAM","7.5MG","30","Select","Select",""],["","59267100001","PFIZER","COVID-19","0","Select","Select",""],["","00555097202","AMPHET\/DEXTR ","10MG","60","Select","Select",""],["","00093314705","CEPHALEXIN ","500MG","14","Select","Select",""],["","65862001705","AMOXICILLIN ","500MG","30","Select","Select",""],["","62542030117","HYD ","10-8\/5ML","100","Select","Select",""],["","00228203150","ALPRAZOLAM ","1MG","30","Select","Select",""],["","00173085910","BREO ","100-25","-60","Select","Select",""],["","00555088602","ESTRADIOL ","1MG","90","Select","Select",""],["","00173069500","ADVAIR ","100\/50","-60","Select","Select",""],["","00378932032","WIXELA ","100\/50","60","Select","Select",""],["","62559015001","EST ","MTEST HS","-30","Select","Select",""],["","00406037605","HYDROCO\/APAP ","5-300MG","12","Select","Select",""],["","29300012410","MELOXICAM ","7.5MG","30","Select","Select",""],["","59267100001","PFIZER ","COVID-19","0","Select","Select",""],["","00781185220","AMOX\/K ","875-125","-20","Select","Select",""],["","57237000511","FLUCONAZOLE","150MG","-1","Select","Select",""],["","00781185220","AMOX\/K","875-125","20","Select","Select",""],["","57237000511","FLUCONAZOLE ","TAB 150MG","-1","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":""}]}]}