{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JERRI   K POWELL","gend":1,"add":"610 LAKELAND CRES","city":"YORKTOWN","state":"VA","zip":"23693-9998","dob":"1957-01-29","age":"","mstatus":"","insh":"2230947*01","cliId":"","pno":"757\/865-4442","cno":"757\/865-4442","email":"","ename":"","eno":"","pphy":"RAINES, TIMOTHY L MD","ppno":"757\/964-7629","pcpadd":"2240 D COLISEUM DR","pcpcity":"HAMPTON","pcpstate":"VA","pcpzip":23666,"pcpcounty":"","pcpid":510027,"pcpname":"","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"757\/353-1877","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/964-7630","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G47.61","G47.33","Z00.00","I10.","E78.00","R73.01","K90.0","R31.29","M25.562","Z23.","I44.0","I49.1","I49.3","R00.2","H25.812","Z12.31","T78.40XA","Z01.419","Z12.4","H90.3","H90.6","H73.891","H25.811","Z85.828","L82.1","B35.3","D23.9","L82.0","Z85.3","M19.90","E78.5","E66.01","H90.A32","H52.223","H47.012","H46.9","Z98.890","H47.322","H05.89","H59.89","H47.329"],"date":["2021-01-14","2021-07-22","2021-07-02","2021-06-14","2021-06-14","2021-06-14","2021-06-14","2021-06-14","2020-11-30","2021-06-14","2020-06-22","2020-07-23","2020-07-23","2020-06-22","2021-02-09","2021-01-08","2021-02-25","2021-06-14","2021-06-14","2020-06-08","2020-06-08","2020-06-08","2021-02-25","2020-12-15","2020-12-15","2020-12-15","2020-12-15","2020-12-15","2021-01-08","2021-02-25","2021-02-25","2020-05-22","2020-06-08","2020-11-20","2021-07-02","2021-08-30","2021-07-29","2021-07-29","2021-07-29","2021-07-29","2021-07-29"],"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":[["","68645056854","ATORVASTATIN","40MG","90","Select","Select",""],["","00093078701","ATENOLOL","25MG","45","Select","Select",""],["","51672130308","ECONAZOLE","1%","85","Select","Select",""],["","60758011905","PREDNISOLONE","1% OP","-5","Select","Select",""],["","17478071310","OFLOXACIN","0.3% OP","5","Select","Select",""],["","58160088552","FLUARIX","2020-21","0","Select","Select",""],["","42571036299","CLOBETASOL","0.05%","50","Select","Select",""],["","68645056854","ATORVASTATIN ","40MG","90","Select","Select",""],["","00093078701","ATENOLOL ","25MG","45","Select","Select",""],["","58160088552","FLUARIX ","2020-21","0","Select","Select",""],["","51672130308","ECONAZOLE ","1%","85","Select","Select",""],["","60758011905","PREDNISOLONE ","1% OP","10","Select","Select",""],["","17478071310","OFLOXACIN ","0.3% OP","-5","Select","Select",""],["","42571036299","CLOBETASOL ","0.05%","50","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","",""],["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":""}]}]}