{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CORRANDA   N WILLIAMS","gend":1,"add":"526 HUNTERS BRIDGE DR","city":"CHESAPEAKE","state":"VA","zip":"23320-9998","dob":"1997-09-25","age":"","mstatus":"","insh":"2349424*01","cliId":"","pno":"757\/610-6292","cno":"757\/610-6292","email":"","ename":"","eno":"","pphy":"PAULSEN, MICHELLE DO","ppno":"757\/495-0606","pcpadd":"SUITE 103 516 INNOVATION DRIVE","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":23320,"pcpcounty":"","pcpid":131473,"pcpname":"","plan":"OHP","program":"ACA","lob":"Individual","region":"TIDEWATER","aligned":"","ano":"757\/610-6292","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/842-6605","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z02.0","R50.9","R19.7","N76.0","B37.3","L30.9","Z11.3","Z12.4","B15.9","B16.1","B18.2","B20.","Z13.89","Z86.2","E78.5","L25.9","Z01.419","B35.4","L02.224","N90.9","Z13.220"],"date":["2021-06-14","2021-06-15","2021-06-15","2021-06-20","2021-06-20","2021-06-20","2021-11-18","2021-04-23","2021-05-11","2021-05-11","2021-05-11","2021-11-18","2021-10-28","2021-10-28","2021-01-07","2021-03-18","2021-04-23","2021-05-27","2021-05-14","2021-06-18","2021-11-18"],"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":[["","49702024613","DOVATO ","50-300MG","30","Select","Select",""],["","00093321915","KETOCONAZOLE ","2%","15","Select","Select",""],["","24658031205","DOXYCYCL ","100MG","14","Select","Select",""],["","59746000103","METHYLPRED ","4MG","21","Select","Select",""],["","68462010340","FLUCONAZOLE ","150MG","1","Select","Select",""],["","00378427677","VALACYCLOVIR ","1GM","21","Select","Select",""],["","29300022705","METRONIDAZOL ","500MG","14","Select","Select",""],["","68462019005","NAPROXEN ","500MG","20","Select","Select",""],["","49702024613","DOVATO","50-300MG","30","Select","Select",""],["","00093321915","KETOCONAZOLE","2%","15","Select","Select",""],["","59746000103","METHYLPRED","4MG","21","Select","Select",""],["","24658031205","DOXYCYCL","100MG","14","Select","Select",""],["","68462010340","FLUCONAZOLE","150MG","1","Select","Select",""],["","59746032537","VALACYCLOVIR","1GM","21","Select","Select",""],["","29300022705","METRONIDAZOL","500MG","14","Select","Select",""],["","68462019005","NAPROXEN","500MG","20","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":""}]}]}