{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CIERRA   D WEATHERLY","gend":1,"add":"1764 BUCKLEY ARCH","city":"VIRGINIA BEACH","state":"VA","zip":"23453-9998","dob":"1979-05-31","age":"","mstatus":"","insh":"2138550*01","cliId":"","pno":"757\/332-0531","cno":"757\/332-0531","email":"","ename":"","eno":"","pphy":"RICASA, JOCELYN MD","ppno":"757\/305-1797","pcpadd":"STE 220 828 HEALTHY WAY","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23462,"pcpcounty":"","pcpid":143824,"pcpname":"BON SECOURS MEDICAL ASSOCIATES","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/309-4715","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N64.4","Z80.3","Z12.4","Z11.51","Z00.00","Z23.","F41.9","Z79.899","E53.8","E55.9","Z68.25","S40.861A","L81.4","L82.1","I78.1","D22.9","Z12.83","Z85.828","Z71.9","Z01.419","Z12.39","R92.2","J06.9","J02.9","N63.11","R21.","B02.8","Z12.31","Z20.828","J45.20","N84.1","L82.0","Z30.09","Z12.12","E78.5","Z76.89"],"date":["2021-05-11","2020-12-11","2021-10-22","2020-10-13","2021-10-26","2021-10-28","2021-10-28","2020-10-27","2021-10-28","2021-10-28","2021-10-28","2020-09-09","2020-09-09","2020-09-09","2020-09-09","2020-09-09","2020-09-09","2020-09-09","2020-09-09","2021-10-19","2021-10-27","2021-05-11","2020-02-20","2020-02-20","2020-09-09","2021-07-16","2021-10-28","2021-09-23","2021-08-11","2021-10-28","2021-10-22","2021-11-04","2021-10-19","2021-10-19","2021-10-28","2021-10-28"],"priorHcc":["","",null,"",null,null,null,"",null,null,null,"","","","","","","","",null,null,"","","","","",null,"",null,null,null,null,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":[["","00527293341","PREDNISONE","10MG","16","Select","Select",""],["","00173071920","FLOVENT","110MCG","-12","Select","Select",""],["","70710101002","OSELTAMIVIR","75MG","7","Select","Select",""],["","66993001968","ALBUTEROL","HFA","18","Select","Select",""],["","51991070405","ALPRAZOLAM","0.25MG","30","Select","Select",""],["","00173068220","VENTOLIN","","18","Select","Select",""],["","65862064163","AZITHROMYCIN","250MG","6","Select","Select",""],["","68180095604","CLOBETASOL","0.05%","60","Select","Select",""],["","61314030802","AZELASTINE","0.05%","6","Select","Select",""],["","51991070405","ALPRAZOLAM ","0.25MG","30","Select","Select",""],["","65862064163","AZITHROMYCIN ","250MG","6","Select","Select",""],["","00527293341","PREDNISONE ","10MG","16","Select","Select",""],["","00173071920","FLOVENT ","110MCG","12","Select","Select",""],["","70710101002","OSELTAMIVIR ","75MG","7","Select","Select",""],["","66993001968","ALBUTEROL ","HFA","18","Select","Select",""],["","00173068220","VENTOLIN ","","18","Select","Select",""],["","68180095604","CLOBETASOL ","0.05%","60","Select","Select",""],["","61314030802","AZELASTINE ","0.05%","6","Select","Select",""],["","69097081312","GABAPENTIN ","100MG","90","Select","Select",""],["","69097081312","GABAPENTIN","100MG","120","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":""}]}]}