{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SUMMER   B MACE","gend":1,"add":"964 GAS LIGHT LN","city":"VIRGINIA BEACH","state":"VA","zip":"23462-9998","dob":"1995-09-07","age":"","mstatus":"","insh":"2173091*01","cliId":"","pno":"804\/477-2427","cno":"804\/477-2427","email":"","ename":"","eno":"","pphy":"CHAKRABORTTY, SAGHANA B MD","ppno":"757\/738-1300","pcpadd":"4421 VA BEACH BLVD SUITE 114","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23462,"pcpcounty":"","pcpid":207903,"pcpname":"","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"","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":["R09.82","J40.","J45.901","Z23.","Z01.419","Z11.59","Z03.818","Z20.828","F41.1"],"date":["2020-01-08","2020-01-08","2020-01-08","2020-02-03","2020-12-31","2020-07-20","2020-07-20","2021-03-28","2021-10-26"],"priorHcc":["","","","","","","","",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":[["","60505082901","FLUTICASONE","50MCG","16","Select","Select",""],["","00591544310","PREDNISONE","20MG","21","Select","Select",""],["","00093227534","AMOX\/K","875-125","20","Select","Select",""],["","00052027303","NUVARING","","1","Select","Select",""],["","67877057305","BENZONATATE","100MG","15","Select","Select",""],["","65862044890","VALACYCLOVIR","500MG","6","Select","Select",""],["","66993060536","ETONOGESTERE","ETHY EST","1","Select","Select",""],["","66993060536","ETONOGESTREL","ETHY EST","1","Select","Select",""],["","58160088552","FLUARIX","2020-21","0","Select","Select",""],["","19515081652","FLULAVAL","2020-21","0","Select","Select",""],["","67877057305","BENZONATATE ","100MG","15","Select","Select",""],["","00591544310","PREDNISONE ","20MG","21","Select","Select",""],["","60505082901","FLUTICASONE ","50MCG","-16","Select","Select",""],["","00093227534","AMOX\/K ","875-125","20","Select","Select",""],["","66993060536","ETONOGESTERE ","ETHY EST","1","Select","Select",""],["","00052027303","NUVARING ","","1","Select","Select",""],["","65862044890","VALACYCLOVIR ","500MG","6","Select","Select",""],["","66993060536","ETONOGESTREL ","ETHY EST","1","Select","Select",""],["","58160088552","FLUARIX ","2020-21","0","Select","Select",""],["","19515081652","FLULAVAL ","2020-21","0","Select","Select",""],["","69097084805","ESCITALOPRAM ","10MG","30","Select","Select",""],["","69097084805","ESCITALOPRAM","10MG","-30","Select","Select",""],["","80777027315","MODERNA ","INJ COVID-19","0","Select","Select",""],["","70461032103","FLUCLVX ","INJ 2021-22","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":""}]}]}