{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ASHLEIGH   RAYNOR COOPER-HARRIS","gend":1,"add":"PO BOX 4914","city":"VIRGINIA BEACH","state":"VA","zip":"23454-9998","dob":"1985-06-30","age":"","mstatus":"","insh":"2261732*01","cliId":"","pno":"757\/478-6778","cno":"757\/478-6778","email":"","ename":"","eno":"","pphy":"MCDERMOTT, GLENN R MD","ppno":"757\/343-4221","pcpadd":"STE 400 1788 REPUBLIC RD","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23454,"pcpcounty":"","pcpid":158123,"pcpname":"","plan":"OHP","program":"ACA","lob":"Individual","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/496-2069","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F90.9","Z79.899","F90.0","N92.1","Z13.220","Z13.1","D21.9","N83.201","J45.20","N83.292","D25.9","Z00.00","D25.1","N83.202","R10.2","Z12.4","Z01.419","Z72.0","R14.0","M25.559","Z11.3","Z20.2"],"date":["2021-05-25","2021-05-25","2020-06-22","2020-10-21","2020-06-22","2020-06-22","2021-01-27","2021-05-25","2020-03-23","2021-01-22","2021-06-30","2020-09-24","2020-10-21","2021-01-22","2021-07-09","2021-07-09","2021-07-09","2021-07-09","2021-06-30","2021-06-30","2021-06-30","2021-06-30"],"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":[["","69452015120","VITAMIN","50000UNT","-4","Select","Select",""],["","66993001968","ALBUTEROL","HFA","18","Select","Select",""],["","00173068220","VENTOLIN","","18","Select","Select",""],["","00555097302","AMPHET\/DEXTR","20MG","60","Select","Select",""],["","54092038701","ADDERALL","20MG","30","Select","Select",""],["","49281042050","FLUZONE","2020-21","0","Select","Select",""],["","69452015120","VITAMIN ","50000UNT","4","Select","Select",""],["","00555097302","AMPHET\/DEXTR ","20MG","60","Select","Select",""],["","00173068220","VENTOLIN ","","18","Select","Select",""],["","66993001968","ALBUTEROL ","HFA","18","Select","Select",""],["","49281042050","FLUZONE ","2020-21","0","Select","Select",""],["","54092038701","ADDERALL ","20MG","30","Select","Select",""],["","00074003828","ORILISSA ","150MG","28","Select","Select",""],["","00074003828","ORILISSA","150MG","28","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":""}]}]}