{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JUANA CASTRO DE MEJIA","gend":1,"add":"1517 HEDGEROW DR","city":"VIRGINIA BEACH","state":"VA","zip":"23455-9998","dob":"1952-08-22","age":"","mstatus":"","insh":"2134282*02","cliId":"","pno":"757\/729-5551","cno":"757\/593-8375","email":"","ename":"","eno":"","pphy":"TAN-GONZALES, DESIREE MD","ppno":"757\/548-0076","pcpadd":"725 VOLVO PKWY SUITE 100","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":23320,"pcpcounty":"","pcpid":129852,"pcpname":"Volvo Medical Associates","plan":"OHP","program":"ACA","lob":"Individual","region":"TIDEWATER","aligned":"","ano":"757\/593-8375","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Q78.2","I10.","E11.65","Z12.31","M81.0","Z78.0","Z79.899","N17.9","E87.1","R10.9","K80.50","Z79.4","Z00.01","E11.40","D50.8","R10.11","R11.0","R91.8","R07.9","N28.9","D50.9","Z20.822","Z12.11","N19.","K80.20","Z20.828","R10.13","R11.2","E11.22","E86.0","R77.8","I12.9","N18.9","Z79.83","H25.813","H35.61","H43.812","R42.","E10.3512","E10.3511","E16.2","E23.6","Z96.1"],"date":["2020-01-03","2021-07-06","2021-07-13","2021-03-10","2021-02-19","2020-01-07","2020-01-07","2021-02-20","2021-02-20","2021-02-20","2021-02-20","2021-02-20","2020-07-20","2021-03-17","2020-07-23","2021-02-19","2021-07-06","2021-02-19","2021-02-19","2021-03-04","2021-03-04","2021-03-16","2021-05-23","2021-02-21","2021-02-21","2020-09-21","2021-02-19","2021-07-09","2021-02-19","2021-02-19","2021-02-19","2021-02-19","2021-02-19","2021-02-19","2021-07-13","2021-10-26","2021-07-13","2021-07-09","2021-10-26","2021-10-26","2021-07-06","2021-10-28","2021-10-26"],"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":[["","00169643810","LEVEMIR","FLEXTOUC","15","Select","Select",""],["","43547033810","BENAZEPRIL","40MG","90","Select","Select",""],["","68180072003","AMLODIPINE","5MG","30","Select","Select",""],["","00006008131","JANUMET","100-1000","30","Select","Select",""],["","65862032904","ALENDRONATE","70MG","8","Select","Select",""],["","65862001099","METFORMIN","1000MG","90","Select","Select",""],["","45963055650","GABAPENTIN","300MG","-90","Select","Select",""],["","00006011231","JANUVIA","50MG","-30","Select","Select",""],["","08396900700","CLICKFINE","32GX5\/32","-100","Select","Select",""],["","00002143380","TRULICITY","0.75\/0.5","2","Select","Select",""],["","08290320550","BD PEN NEEDL","32GX5\/32","100","Select","Select",""],["","65862085901","FAMOTIDINE","20MG","30","Select","Select",""],["","59267100002","PFIZER","COVID-19","0","Select","Select",""],["","00006008131","JANUMET ","100-1000","30","Select","Select",""],["","65862032904","ALENDRONATE ","70MG","4","Select","Select",""],["","43547033810","BENAZEPRIL ","40MG","90","Select","Select",""],["","00169643810","LEVEMIR ","FLEXTOUC","6","Select","Select",""],["","68180072003","AMLODIPINE ","5MG","30","Select","Select",""],["","45963055650","GABAPENTIN ","300MG","-90","Select","Select",""],["","65862001099","METFORMIN ","1000MG","90","Select","Select",""],["","00006011231","JANUVIA ","50MG","15","Select","Select",""],["","08290320122","BD  PEN NEEDL","32GX4MM","100","Select","Select",""],["","08396900700","CLICKFINE ","32GX5\/32","100","Select","Select",""],["","65862085901","FAMOTIDINE ","20MG","30","Select","Select",""],["","00002143380","TRULICITY ","0.75\/0.5","2","Select","Select",""],["","59267100002","PFIZER ","COVID-19","0","Select","Select",""],["","68382004001","PROMETHAZINE ","12.5MG","8","Select","Select",""],["","59746012106","MECLIZINE ","25MG","30","Select","Select",""],["","57237007710","ONDANSETRON ","4MG ODT","20","Select","Select",""],["","59746012106","MECLIZINE","25MG","30","Select","Select",""],["","68382004001","PROMETHAZINE","12.5MG","8","Select","Select",""],["","57237007710","ONDANSETRON","4MG ODT","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":[[["Yes","Select","","","","","Select","",""],["Yes","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":""}]}]}