{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"HEATHER CAFINI","gend":1,"add":"1632 FLANAGANS LN","city":"VIRGINIA BEACH","state":"VA","zip":"23456-9998","dob":"1978-06-24","age":"","mstatus":"","insh":"2056764*02","cliId":"","pno":"757\/334-2230","cno":"757\/334-2230","email":"","ename":"","eno":"","pphy":"MOSELEY, HEATHER MD","ppno":"757\/689-8430","pcpadd":"1925 GLEN MITCHELL DR. STE 100","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23456,"pcpcounty":"","pcpid":110777,"pcpname":"Princess Anne Medical Associates","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"757\/333-2981","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/689-8435","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["T84.84XA","S83.241A","S83.231D","D48.5","S42.021D","S83.231A","M25.511","S41.001S","L90.5","S83.241D","M65.861","M22.41","M25.461","E03.9","J45.909","Z79.891","Z79.890","Z79.899","M54.2","M25.559","Z78.0","Z13.220","E03.4","Z12.31"],"date":["2020-01-16","2020-03-02","2020-05-12","2021-05-25","2020-03-20","2020-03-02","2020-01-08","2020-01-16","2020-01-16","2020-03-20","2020-03-02","2020-03-02","2020-03-02","2020-03-02","2020-03-02","2020-03-02","2020-03-02","2020-03-02","2020-11-17","2020-11-17","2020-11-17","2021-06-28","2021-07-27","2021-06-11"],"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":[["","68180012202","CEPHALEXIN","500MG","9","Select","Select",""],["","00406012301","HYDROCO\/APAP","5-325MG","40","Select","Select",""],["","68382004101","PROMETHAZINE","25MG","40","Select","Select",""],["","29300012401","MELOXICAM","7.5MG","90","Select","Select",""],["","68180015301","DESLORATADIN","5MG","-90","Select","Select",""],["","00456045701","ARMOUR","15MG","-90","Select","Select",""],["","69097084615","CYCLOBENZAPR","10MG","30","Select","Select",""],["","13811071910","NITROFURANTN","100MG","14","Select","Select",""],["","59310057922","PROAIR","","-8","Select","Select",""],["","31722072610","MONTELUKAST","10MG","30","Select","Select",""],["","65862064163","AZITHROMYCIN","250MG","6","Select","Select",""],["","00093317431","ALBUTEROL","HFA","8","Select","Select",""],["","62332054760","CLOBETASOL","0.05%","60","Select","Select",""],["","00406012301","HYDROCO\/APAP ","5-325MG","40","Select","Select",""],["","68180012202","CEPHALEXIN ","500MG","9","Select","Select",""],["","29300012401","MELOXICAM ","7.5MG","90","Select","Select",""],["","68382004101","PROMETHAZINE ","25MG","40","Select","Select",""],["","69097084615","CYCLOBENZAPR ","10MG","30","Select","Select",""],["","68180015301","DESLORATADIN ","5MG","-90","Select","Select",""],["","00456045801","ARMOUR ","30MG","90","Select","Select",""],["","13811071910","NITROFURANTN ","100MG","14","Select","Select",""],["","31722072610","MONTELUKAST ","10MG","30","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","00093317431","ALBUTEROL ","HFA","8","Select","Select",""],["","62332054760","CLOBETASOL ","0.05%","60","Select","Select",""],["","65862064163","AZITHROMYCIN ","250MG","6","Select","Select",""],["","42192032901","NP ","30MG","30","Select","Select",""],["","42192032901","NP","30MG","-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","",""],["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":""}]}]}