{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ALAINA AGNESE","gend":1,"add":"1260 MOZART DR","city":"VIRGINIA BEACH","state":"VA","zip":"23454-9998","dob":"1993-01-31","age":"","mstatus":"","insh":"2258556*01","cliId":"","pno":"757\/652-4833","cno":"757\/652-4833","email":"","ename":"","eno":"","pphy":"REED, SHARON B MD","ppno":"757\/622-8358","pcpadd":"930 W 21ST ST SUITE 100","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23517,"pcpcounty":"","pcpid":156143,"pcpname":"","plan":"OHP","program":"ACA","lob":"Individual","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":["K52.9","Z68.1","K63.3","F17.290","F90.9","G89.29","R63.4","R70.0","Z90.49","Z88.5","L53.8","R10.30","R10.9","R19.7","R11.0","R00.2","R53.83","D50.9","R42.","K31.9","K29.50","R93.89","K58.9","K63.89","R11.2","K58.0","R10.32","R10.13","F17.210","R10.84","R10.829","R10.33","K90.0","K86.81","Z87.19","K92.1","R93.5","K29.70","B37.0","R18.8","R93.3","Z20.828","Z11.3","Z11.4","R30.0","Z03.818","K31.89","N76.0","B37.3","R10.31","Z90.89","Z98.890"],"date":["2021-06-29","2020-02-04","2020-02-04","2020-02-04","2020-02-17","2021-06-29","2020-02-05","2020-02-03","2021-04-09","2021-06-29","2020-02-03","2021-04-09","2021-06-29","2021-06-17","2021-06-17","2020-05-29","2020-05-29","2020-05-29","2020-05-29","2020-10-01","2020-10-01","2021-04-16","2021-06-17","2021-06-29","2021-06-29","2020-11-27","2021-05-27","2021-05-27","2021-06-29","2021-05-27","2021-04-09","2021-04-09","2021-06-29","2021-06-29","2021-06-29","2021-06-29","2020-02-05","2020-06-24","2021-07-09","2020-01-02","2020-02-04","2021-02-09","2021-03-08","2021-03-08","2021-05-29","2020-06-18","2020-10-01","2021-05-29","2021-05-29","2020-05-14","2021-05-04","2021-05-04"],"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":[["","60505283203","ATOMOXETINE ","25MG","30","Select","Select",""],["","00378137578","MESALAMINE ","0.375GM","120","Select","Select",""],["","65162062711","TRAMADOL ","50MG","28","Select","Select",""],["","42858010201","OXYCOD\/APAP ","5-325MG","10","Select","Select",""],["","65162074510","PROMETHAZINE ","12.5MG","16","Select","Select",""],["","43386009019","GAVILYTE-G ","","4000","Select","Select",""],["","65862018730","ONDANSETRON ","4MG","30","Select","Select",""],["","65649030302","XIFAXAN ","550MG","42","Select","Select",""],["","61874010060","VIBERZI ","100MG","60","Select","Select",""],["","59267100003","PFIZER ","COVID-19","0","Select","Select",""],["","70710113908","FLUCONAZOLE ","150MG","2","Select","Select",""],["","00185012201","NITROFURANTN ","100MG","10","Select","Select",""],["","66689000816","NYSTATIN ","100000","140","Select","Select",""],["","42192080201","PHENAZOPYRID ","200MG","9","Select","Select",""],["","29300022705","METRONIDAZOL ","500MG","14","Select","Select",""],["","0","","","300","Select","Select",""],["","70710122501","AMITRIPTYLIN ","10MG","30","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":""}]}]}