{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MACY   E COMBS","gend":1,"add":"5003 BENSON CT","city":"SUFFOLK","state":"VA","zip":"23435-9998","dob":"1996-11-18","age":"","mstatus":"","insh":"2295618*01","cliId":"","pno":"740\/538-3259","cno":"740\/538-3259","email":"","ename":"","eno":"","pphy":"SEREM, MAUREEN C MD","ppno":"757\/606-1656","pcpadd":"3235 BRIDGE RD STE 15","pcpcity":"SUFFOLK","pcpstate":"VA","pcpzip":23435,"pcpcounty":"","pcpid":157406,"pcpname":"North Suffolk Family Medicine","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/606-1657","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R00.2","R10.2","R55.","Z30.09","N92.1","G40.209","S50.862A","R53.83","R00.0","R06.02","Z88.0","Z88.1","Z86.59","R42.","R26.2","L90.5","R07.9","R79.1","M54.16","M54.5","R53.1","G47.9","M47.26","R87.612","Z12.4","J04.0","I49.8","H61.21","J02.9","Z11.52","R06.00","Z20.828","G51.2","Z20.822"],"date":["2021-08-05","2020-12-04","2021-02-12","2020-12-04","2020-12-04","2021-02-15","2020-05-17","2021-01-26","2021-01-28","2021-01-26","2021-03-01","2021-03-01","2021-01-26","2021-01-26","2021-08-02","2020-12-21","2021-08-05","2021-01-26","2021-04-13","2021-04-30","2021-01-28","2021-04-07","2021-04-29","2021-03-04","2021-03-04","2021-07-19","2021-09-21","2021-07-19","2021-07-06","2021-07-06","2021-08-05","2021-09-17","2021-09-21","2021-09-14"],"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":[["","00430054050","MINASTRIN","FE","28","Select","Select",""],["","68462037629","NORETH\/ETHIN","FE 1\/20","84","Select","Select",""],["","68180086673","BLISOVI","1.5\/30","84","Select","Select",""],["","59746000103","METHYLPRED","4MG","21","Select","Select",""],["","68462085229","CHARLOTTE","FE 1\/20","28","Select","Select",""],["","00054418125","DEXAMETHASON","1MG","1","Select","Select",""],["","68180086673","BLISOVI ","1.5\/30","84","Select","Select",""],["","42571025201","CLINDAMYCIN ","300MG","30","Select","Select",""],["","59746000103","METHYLPRED ","4MG","21","Select","Select",""],["","00430054050","MINASTRIN ","FE","-28","Select","Select",""],["","68462085229","CHARLOTTE ","FE 1\/20","28","Select","Select",""],["","00054418125","DEXAMETHASON ","1MG","1","Select","Select",""],["","68462037629","NORETH\/ETHIN ","FE 1\/20","84","Select","Select",""],["","00093314705","CEPHALEXIN ","500MG","20","Select","Select",""],["","00093314705","CEPHALEXIN","500MG","20","Select","Select",""],["","42571025201","CLINDAMYCIN","300MG","30","Select","Select",""],["","60505082901","FLUTICASONE","50MCG","16","Select","Select",""],["","60505082601","IPRATROPIUM","0.03%","30","Select","Select",""],["","60505082901","FLUTICASONE ","SPR 50MCG","16","Select","Select",""],["","60505082601","IPRATROPIUM ","SPR 0.0003","30","Select","Select",""],["","42799080601","IVERMECTIN ","TAB 3MG","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","",""],["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":""}]}]}