{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"AMANDA MARTIN","gend":1,"add":"1004 AZALEA CT APT B2","city":"NORFOLK","state":"VA","zip":"23507-9998","dob":"1992-06-13","age":"","mstatus":"","insh":"2082789*01","cliId":"","pno":"757\/647-7040","cno":"757\/647-7040","email":"","ename":"","eno":"","pphy":"PALMISANO, DAVID MD","ppno":"757\/410-4488","pcpadd":"1024 S BATTLEFIELD BLVD","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":23320,"pcpcounty":"","pcpid":120527,"pcpname":"Hanbury Family Medicine","plan":"OHP","program":"ACA","lob":"Individual","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/410-4450","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z23.","H81.92","J45.909","J30.2","F32.9","Z71.9","Z30.41","Z01.419","Z68.41","Z00.00","J44.9","Z71.89","T23.242A","T31.0","Z79.899","T23.002A","S92.902D","G43.109","E66.9","E28.2","S92.425A","J01.00","Z20.828","Z11.3","R39.9","N30.00","B95.5"],"date":["2021-04-26","2020-11-27","2021-07-23","2020-04-15","2020-09-28","2020-04-15","2021-09-22","2021-09-22","2021-09-22","2021-10-12","2020-09-28","2021-07-23","2020-05-05","2020-05-05","2020-05-05","2020-05-05","2021-07-16","2021-07-23","2021-07-23","2021-09-22","2021-05-02","2021-06-01","2021-08-05","2021-09-22","2021-09-28","2021-10-12","2021-10-04"],"priorHcc":["","","","","","","","","",null,"","","","","","","","","","","","","","",null,null,null]}},{"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":[["","68180031909","BUPROPN","150MG XL","30","Select","Select",""],["","45802008801","ALBUTEROL","HFA","8","Select","Select",""],["","42858010201","OXYCOD\/APAP","5-325MG","18","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","51991070505","ALPRAZOLAM","0.5MG","45","Select","Select",""],["","00555901658","SPRINTEC","28 DAY","84","Select","Select",""],["","31722072610","MONTELUKAST","10MG","90","Select","Select",""],["","16103038711","MECLIZINE","25MG","30","Select","Select",""],["","59779081710","CVS","0.05%","30","Select","Select",""],["","65862007701","CIPROFLOXACN","500MG","10","Select","Select",""],["","59746000103","METHYLPRED","4MG","21","Select","Select",""],["","68180031909","BUPROPN ","150MG XL","30","Select","Select",""],["","00555901658","SPRINTEC ","28 DAY","84","Select","Select",""],["","45802008801","ALBUTEROL ","HFA","8","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","51991070505","ALPRAZOLAM ","0.5MG","45","Select","Select",""],["","42858010201","OXYCOD\/APAP ","5-325MG","18","Select","Select",""],["","65862007701","CIPROFLOXACN ","500MG","10","Select","Select",""],["","16103038711","MECLIZINE ","25MG","30","Select","Select",""],["","31722072610","MONTELUKAST ","10MG","90","Select","Select",""],["","59746000103","METHYLPRED ","4MG","21","Select","Select",""],["","59779081710","CVS ","0.05%","30","Select","Select",""],["","72618300002","NURTEC ","75MG ODT","30","Select","Select",""],["","72618300002","NURTEC","75MG ODT","30","Select","Select",""],["","67877021905","CEPHALEXIN","500MG","15","Select","Select",""],["","68462011944","FLUCONAZOLE","150MG","2","Select","Select",""],["","75826011510","PHENAZOPYRID","200MG","6","Select","Select",""],["","65862017601","PENICILLN","500MG","20","Select","Select",""],["","68462011944","FLUCONAZOLE ","TAB 150MG","-2","Select","Select",""],["","75826011510","PHENAZOPYRID ","TAB 200MG","6","Select","Select",""],["","67877021905","CEPHALEXIN ","CAP 500MG","15","Select","Select",""],["","65862017601","PENICILLN ","TAB 500MG","20","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":""}]}]}