{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"PAULA   A SUBASIC","gend":1,"add":"4792 DADSON CT APT #101","city":"VIRGINIA BEACH","state":"VA","zip":"23455-9998","dob":"1968-10-22","age":"","mstatus":"","insh":"3172376*01","cliId":"","pno":"757\/773-1240","cno":"757\/773-1240","email":"","ename":"","eno":"","pphy":"HART, KAREN MD","ppno":"757\/301-7729","pcpadd":"813 INDEPENDENCE BLVD SUITE A","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23455,"pcpcounty":"","pcpid":175410,"pcpname":"ATLANTIC COAST FAMILY MEDICINE","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/301-7837","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["C54.1","E04.1","Z12.31","Z12.11","Z12.12","R91.1","J43.9","R10.32","N71.9","R53.83","E55.9","N85.00","Z00.00","N93.8","R30.0","Z00.01","E78.5","R73.01","R31.29","Z01.810","Z01.812","M54.89","N89.8","R10.13","D25.1","Z11.59","R91.8","K82.8","Z90.710","Z20.822","R06.02","R60.1","R60.0","F17.210","Z85.42","R20.0"],"date":["2021-08-25","2020-12-07","2021-01-19","2020-02-09","2020-02-09","2021-05-06","2021-05-06","2020-07-02","2020-06-25","2020-06-25","2020-06-25","2020-07-02","2020-12-07","2020-06-25","2021-03-06","2020-12-07","2020-12-07","2020-12-07","2020-12-07","2020-07-06","2020-07-06","2021-03-05","2021-03-05","2021-03-05","2020-01-14","2020-07-14","2021-03-11","2021-03-11","2021-03-11","2021-08-20","2021-11-15","2021-11-15","2021-11-15","2021-11-15","2021-11-15","2021-11-15"],"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":[["","53489012002","DOXYCYCL ","100MG","-20","Select","Select",""],["","00406051205","OXYCOD\/APAP ","5-325MG","20","Select","Select",""],["","16714069211","FLUCONAZOLE ","150MG","2","Select","Select",""],["","70461032003","FLUCLVX ","2020-21","0","Select","Select",""],["","00185012201","NITROFURANTN ","100MG","10","Select","Select",""],["","42192080201","PHENAZOPYRID ","200MG","9","Select","Select",""],["","53489012002","DOXYCYCL","100MG","-20","Select","Select",""],["","00406051205","OXYCOD\/APAP","5-325MG","-20","Select","Select",""],["","16714069211","FLUCONAZOLE","150MG","2","Select","Select",""],["","70461032003","FLUCLVX","2020-21","0","Select","Select",""],["","00185012201","NITROFURANTN","100MG","10","Select","Select",""],["","42192080201","PHENAZOPYRID","200MG","9","Select","Select",""],["","49281042150","FLUZONE","2021-22","0","Select","Select",""],["","00093506001","HYDROXYZ","10MG","20","Select","Select",""],["","00093506001","HYDROXYZ ","TAB 10MG","20","Select","Select",""],["","00093078710","ATENOLOL ","TAB 25MG","-30","Select","Select",""],["","49281042150","FLUZONE ","INJ 2021-22","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":[[["No","Select","","","","","Select","",""],["No","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":""}]}]}