{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JACQUELINE   O BRAER","gend":1,"add":"748 DIFFDALE LN","city":"CHESAPEAKE","state":"VA","zip":"23320-9998","dob":"1989-04-09","age":"","mstatus":"","insh":"2124426*01","cliId":"","pno":"770\/815-1554","cno":"770\/815-1554","email":"","ename":"","eno":"","pphy":"PACHECO, PARIS MD","ppno":"757\/352-2030","pcpadd":"1168 FIRST COLONIAL RD STE 200","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23454,"pcpcounty":"","pcpid":113694,"pcpname":"Bayview Hospitalist","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/352-2031","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z91.018","E03.9","Z01.419","Z30.431","Z01.84","Z20.7","Z30.09","Z86.718","G43.909","J32.9","R42.","Z00.00","Z12.39","Z97.5","Z12.4","Z11.51","I83.92","Z30.432"],"date":["2020-01-14","2021-11-01","2021-02-04","2020-01-30","2021-02-04","2021-02-04","2021-03-25","2021-11-11","2021-03-25","2020-01-14","2020-01-14","2021-03-25","2021-02-04","2021-02-04","2021-02-04","2021-02-04","2021-11-11","2021-11-11"],"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":[["","00143211205","DOXYCYCL","100MG","20","Select","Select",""],["","11523716201","CLARITIN-D","5-120MG","10","Select","Select",""],["","59746012106","MECLIZINE","25MG","30","Select","Select",""],["","61314063710","PREDNISOLONE","1% OP","10","Select","Select",""],["","00093031401","KETOROLAC","10MG","3","Select","Select",""],["","60505058204","MOXIFLOXACIN","HCL 0.5%","3","Select","Select",""],["","00143924920","AMOX\/K","875-125","14","Select","Select",""],["","19515081652","FLULAVAL","2020-21","0","Select","Select",""],["","69238183007","LEVOTHYROXIN","25MCG","30","Select","Select",""],["","65862039010","ONDANSETRON","4MG ODT","20","Select","Select",""],["","00406048410","APAP\/CODEINE","300-30MG","20","Select","Select",""],["","59746012106","MECLIZINE ","25MG","30","Select","Select",""],["","11523716201","CLARITIN-D ","5-120MG","10","Select","Select",""],["","00143211205","DOXYCYCL ","100MG","20","Select","Select",""],["","19515081652","FLULAVAL ","2020-21","0","Select","Select",""],["","00093031401","KETOROLAC ","10MG","3","Select","Select",""],["","61314063715","PREDNISOLONE ","1% OP","15","Select","Select",""],["","60505058204","MOXIFLOXACIN ","HCL 0.5%","3","Select","Select",""],["","00406048410","APAP\/CODEINE ","300-30MG","20","Select","Select",""],["","65862039010","ONDANSETRON ","4MG ODT","20","Select","Select",""],["","00143924920","AMOX\/K ","875-125","14","Select","Select",""],["","69238183007","LEVOTHYROXIN ","25MCG","30","Select","Select",""],["","58160088752","FLUARIX ","2021-22","0","Select","Select",""],["","58160088752","FLUARIX","2021-22","0","Select","Select",""],["","00006468100","M-M-R","","1","Select","Select",""],["","00006468100","M-M-R ","INJ ","1","Select","Select",""],["","80777027398","MODERNA ","INJ 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","",""],["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":""}]}]}