{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"WENDY   A KIDD","gend":1,"add":"109 CROCKETT ROAD","city":"SEAFORD","state":"VA","zip":"23696-9998","dob":"1978-03-12","age":"","mstatus":"","insh":"4773489*01","cliId":"","pno":"757\/897-8650","cno":"757\/897-8650","email":"","ename":"","eno":"","pphy":"MCALEER-LEAVEY, LAURA MD","ppno":"757\/316-5050","pcpadd":"209 VILLAGE AVE SUITE P","pcpcity":"YORKTOWN","pcpstate":"VA","pcpzip":23693,"pcpcounty":"","pcpid":118380,"pcpname":"Riverside Primary Care Kiln Creek","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/369-2999","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z01.419","Z11.51","K21.9","R06.02","Z12.31","L57.8","D22.5","L82.1","L82.0","L70.0","L72.3","J06.9"],"date":["2021-01-19","2021-01-19","2020-02-01","2020-02-01","2021-08-16","2020-07-14","2020-07-14","2020-07-14","2020-07-14","2020-07-14","2021-10-01","2021-10-12"],"priorHcc":["","","","","","","","","","",null,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":[["","68462072029","DROSPIRENONE","ETHY EST","28","Select","Select",""],["","00472011745","TRETINOIN","0.03%","45","Select","Select",""],["","42806031250","DOXYCYCL","100MG","60","Select","Select",""],["","59762374401","CLINDAMYCIN","10MG\/ML","60","Select","Select",""],["","68462010340","FLUCONAZOLE","150MG","-2","Select","Select",""],["","68462072029","DROSPIRENONE ","ETHY EST","28","Select","Select",""],["","42806031250","DOXYCYCL ","100MG","-60","Select","Select",""],["","59762374401","CLINDAMYCIN ","10MG\/ML","60","Select","Select",""],["","00472011745","TRETINOIN ","0.03%","45","Select","Select",""],["","68462010340","FLUCONAZOLE ","150MG","2","Select","Select",""],["","50111078810","AZITHROMYCIN","500MG","3","Select","Select",""],["","50111078810","AZITHROMYCIN ","TAB 500MG","3","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":""}]}]}