{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ELIZABETH   S ARTZ","gend":1,"add":"3204 REESE DR","city":"PORTSMOUTH","state":"VA","zip":"23703-9998","dob":"1978-05-16","age":"","mstatus":"","insh":"2189187*01","cliId":"","pno":"757\/412-9611","cno":"757\/412-9611","email":"","ename":"","eno":"","pphy":"ZEV, ZAHAN MD","ppno":"757\/705-5265","pcpadd":"2994 CHURCHLAND BLVD","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":23321,"pcpcounty":"","pcpid":101382,"pcpname":"Mid-Atlantic Family Medicine","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"757\/412-9611","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/686-2805","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K50.119","F41.1","K50.10","Z12.4","Z11.59","J02.9","R11.2","R10.9","Z80.0","F41.0","F51.11","Z71.1","Z20.828","B34.9","Z11.1","R45.1","Z01.419","M79.602","Z00.00","F32.9","E87.6","R94.31","R19.7","Z20.822","K50.90","R45.0","H62.8X3","M62.838","R41.82","S09.90XA","R06.02","R00.2","R07.9","G47.00","Z79.899"],"date":["2020-02-24","2021-04-29","2021-08-02","2021-06-08","2020-10-09","2021-03-09","2021-03-09","2021-06-04","2021-06-04","2021-04-29","2020-01-23","2020-03-18","2021-03-07","2021-03-07","2020-07-20","2021-04-29","2021-06-04","2020-12-04","2021-04-12","2020-02-24","2021-03-09","2021-03-09","2021-08-02","2021-03-09","2021-03-09","2020-03-18","2020-07-23","2021-08-16","2021-03-09","2021-03-09","2021-03-09","2021-04-12","2021-04-12","2021-04-28","2021-08-02"],"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":[["","00228203150","ALPRAZOLAM","1MG","60","Select","Select",""],["","65862016001","ZOLPIDEM","10MG","30","Select","Select",""],["","13668013601","ESCITALOPRAM","10MG","90","Select","Select",""],["","65162062711","TRAMADOL","50MG","21","Select","Select",""],["","10702000350","PROMETHAZINE","25MG","12","Select","Select",""],["","51862094205","DIAZEPAM","5MG","10","Select","Select",""],["","00713072615","MOMETASONE","0.10%","-15","Select","Select",""],["","61314064610","NEO\/POLY\/HC","1% OTIC","10","Select","Select",""],["","88888888887","DMR","","1","Select","Select",""],["","63481052910","CORTISPORIN","","-10","Select","Select",""],["","80777027399","MODERNA","COVID-19","0","Select","Select",""],["","68382091634","METHYLPRED","4MG","-21","Select","Select",""],["","59267100002","PFIZER","COVID-19","0","Select","Select",""],["","52817033200","CYCLOBENZAPR","10MG","30","Select","Select",""],["","00713052612","PROMETHEGAN","25MG","14","Select","Select",""],["","65862001705","AMOXICILLIN","500MG","20","Select","Select",""],["","13668013601","ESCITALOPRAM ","10MG","90","Select","Select",""],["","00228203150","ALPRAZOLAM ","1MG","60","Select","Select",""],["","65862016001","ZOLPIDEM ","10MG","30","Select","Select",""],["","65162062711","TRAMADOL ","50MG","21","Select","Select",""],["","10702000350","PROMETHAZINE ","25MG","12","Select","Select",""],["","88888888887","DMR ","","1","Select","Select",""],["","00713072615","MOMETASONE ","0.10%","15","Select","Select",""],["","61314064610","NEO\/POLY\/HC ","1% OTIC","10","Select","Select",""],["","51862094205","DIAZEPAM ","5MG","10","Select","Select",""],["","63481052910","CORTISPORIN ","","10","Select","Select",""],["","59746000103","METHYLPRED ","4MG","21","Select","Select",""],["","52817033200","CYCLOBENZAPR ","10MG","30","Select","Select",""],["","80777027399","MODERNA ","COVID-19","0","Select","Select",""],["","65862001705","AMOXICILLIN ","500MG","20","Select","Select",""],["","00713052612","PROMETHEGAN ","25MG","14","Select","Select",""],["","59267100002","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","",""],["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":""}]}]}