{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JACQUELINE   D UZZLE","gend":1,"add":"2513 OLD GREENBRIER ROAD","city":"CHESAPEAKE","state":"VA","zip":"23325-9998","dob":"1960-02-26","age":"","mstatus":"","insh":"2123484*01","cliId":"","pno":"757\/367-2320","cno":"757\/367-2320","email":"","ename":"","eno":"","pphy":"VAKILY, SIMIN MD","ppno":"757\/455-6368","pcpadd":"SUITE 225 6161 KEMPSVILLE CIR","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23502,"pcpcounty":"","pcpid":125660,"pcpname":"Nowcare Medical Associates","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/455-6686","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I10.","K75.4","I12.9","N18.2","A60.04","E78.5","M32.9","Z00.00","Z12.11","D64.9","M41.9","M53.2X7","M54.5","M51.36","F43.10","N18.30","E78.2","K21.9","R60.0","M47.816","M32.8","M15.3","Z79.899","M35.00","L90.5","M25.552","H25.013","H53.8","M32.10","Z20.828","F48.8","Z79.52","G89.29","Z23.","M54.50"],"date":["2021-10-25","2021-10-15","2020-03-23","2020-03-23","2020-03-23","2020-12-14","2021-10-25","2020-10-01","2021-08-30","2021-10-25","2021-08-30","2020-01-03","2020-01-03","2020-01-03","2020-12-17","2021-10-25","2021-10-25","2021-10-25","2020-07-06","2021-08-30","2020-08-31","2020-08-31","2021-07-22","2020-08-31","2021-08-30","2021-08-30","2020-12-21","2020-12-21","2020-12-21","2021-02-23","2021-07-22","2021-07-22","2021-10-25","2021-10-25","2021-10-25"],"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":[["","68382009601","HYDROXYCHLOR","200MG","-90","Select","Select",""],["","00054429731","FUROSEMIDE","20MG","90","Select","Select",""],["","29300012810","HYDROCHLOROT","25MG","90","Select","Select",""],["","68462034690","LEVOCETIRIZI","5MG","-30","Select","Select",""],["","65162062711","TRAMADOL","50MG","60","Select","Select",""],["","00591505210","PREDNISONE","5MG","-30","Select","Select",""],["","68382079101","ACYCLOVIR","400MG","25","Select","Select",""],["","00378668999","PANTOPRAZOLE","40MG","30","Select","Select",""],["","49884011174","ALPRAZOLAM","0.5MG OD","2","Select","Select",""],["","70377000315","SIMVASTATIN","20MG","90","Select","Select",""],["","00054429731","FUROSEMIDE ","20MG","90","Select","Select",""],["","65162062711","TRAMADOL ","50MG","60","Select","Select",""],["","68382009601","HYDROXYCHLOR ","200MG","30","Select","Select",""],["","59746017210","PREDNISONE ","5MG","30","Select","Select",""],["","29300012810","HYDROCHLOROT ","25MG","90","Select","Select",""],["","68462034690","LEVOCETIRIZI ","5MG","30","Select","Select",""],["","68382079101","ACYCLOVIR ","400MG","25","Select","Select",""],["","00228202996","ALPRAZOLAM ","0.5MG","2","Select","Select",""],["","70377000315","SIMVASTATIN ","20MG","90","Select","Select",""],["","00378668999","PANTOPRAZOLE ","40MG","-90","Select","Select",""],["","59267100001","PFIZER ","COVID-19","0","Select","Select",""],["","59267100001","PFIZER","COVID-19","0","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":""}]}]}