{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TRACI   LYNN SANDERS","gend":1,"add":"4657 BROMFIELD AVE","city":"VIRGINIA BEACH","state":"VA","zip":"23455-9998","dob":"1970-11-30","age":"","mstatus":"","insh":"2331702*02","cliId":"","pno":"757\/961-8943","cno":"757\/961-8943","email":"","ename":"","eno":"","pphy":"BAKHSHI, ELIZABETH MD","ppno":"757\/481-3770","pcpadd":"1821 OLD DONATION PKWY SUITE #4","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23454,"pcpcounty":"","pcpid":120796,"pcpname":"","plan":"OHP","program":"ACA","lob":"Individual","region":"TIDEWATER","aligned":"","ano":"757\/961-8943","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/496-4046","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I10.","E78.2","R73.02","Z68.41","G47.33","M72.2","M79.671","Z79.899","R05.","J45.20","Z01.419","N39.46","Z86.010","Z20.822","R53.83","R06.83","E55.9","D72.89","Z12.11","D12.2","D12.3","K63.5","K57.30","K64.8","K29.50","K31.7","K21.9","E11.9","E66.01","Z87.891","Z88.5","H04.123","H40.013","H33.301","E04.1","R23.2","Z12.31","D12.0","D12.5","K64.9","R13.14","K31.89","J30.0","Z00.00","G89.29","S86.311A","Z11.51","K25.9","R10.9","R07.2","E66.09","Z23.","H26.493"],"date":["2021-07-29","2021-07-29","2021-07-29","2021-07-29","2021-08-25","2021-05-24","2021-05-24","2020-12-08","2020-12-11","2020-12-11","2021-01-05","2021-01-05","2021-01-22","2021-01-22","2021-01-19","2021-01-19","2021-04-16","2021-04-16","2021-01-26","2021-01-26","2021-01-26","2021-01-26","2021-01-26","2021-01-26","2021-01-26","2021-01-26","2021-01-26","2021-03-16","2021-01-26","2021-01-26","2021-01-26","2021-03-16","2021-09-21","2021-03-16","2021-04-22","2021-04-22","2021-05-13","2021-01-26","2021-01-26","2021-01-26","2021-01-26","2021-01-26","2021-04-22","2020-11-20","2021-05-06","2021-05-14","2021-01-05","2021-01-26","2021-01-26","2021-06-21","2021-06-21","2021-07-29","2021-09-21"],"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":[["","00093317431","ALBUTEROL","HFA","8","Select","Select",""],["","31722072690","MONTELUKAST","10MG","90","Select","Select",""],["","57237000299","HYDROCHLOROT","12.5MG","30","Select","Select",""],["","00378718505","METFORMIN","500MG","270","Select","Select",""],["","70377000415","SIMVASTATIN","40MG","90","Select","Select",""],["","33342004910","IRBESARTAN","300MG","90","Select","Select",""],["","62756052169","SUMATRIPTAN","50MG","18","Select","Select",""],["","00002143380","TRULICITY","0.75\/0.5","2","Select","Select",""],["","65862037401","ESCITALOPRAM","10MG","62","Select","Select",""],["","60505083305","AZELASTINE","0.10%","30","Select","Select",""],["","57237000299","HYDROCHLOROT ","12.5MG","30","Select","Select",""],["","31722072690","MONTELUKAST ","10MG","90","Select","Select",""],["","69097084805","ESCITALOPRAM ","10MG","90","Select","Select",""],["","00378718505","METFORMIN ","500MG","270","Select","Select",""],["","70377000415","SIMVASTATIN ","40MG","90","Select","Select",""],["","33342004910","IRBESARTAN ","300MG","90","Select","Select",""],["","62756052169","SUMATRIPTAN ","50MG","18","Select","Select",""],["","00002143380","TRULICITY ","0.75\/0.5","2","Select","Select",""],["","00093317431","ALBUTEROL ","HFA","8","Select","Select",""],["","60505083305","AZELASTINE ","0.10%","30","Select","Select",""],["","59267100002","PFIZER","COVID-19","0","Select","Select",""],["","59267100002","PFIZER ","INJ 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":[[["Yes","Select","","","","","Select","",""],["Yes","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":""}]}]}