{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TERESA GORMAN","gend":1,"add":"201B 54TH ST","city":"VIRGINIA BEACH","state":"VA","zip":"23451-9998","dob":"1963-01-27","pno":"757\/477-5437","cno":"757\/477-5437","email":"","pphy":"","ppno":"","pcpadd":"","pcpcity":"","pcpstate":"","pcpzip":"","pcpcounty":"","pcpid":"","pcpname":"","insh":"5442079*01","cliId":"","plan":"OHP","program":"ACA","lob":"Individual","region":"TIDEWATER","aligned":"","ano":"757\/477-5437","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M25.50","M06.89","M16.0","J01.90","Z12.11","M25.559","M19.072","M06.9","Z79.899","M06.09","Z12.31","M51.16","M47.26","M47.817","M48.07","M43.19","M47.812","M50.122","M48.02","G89.29","M19.90","M17.9","M46.1","E78.2","B02.9","M70.62","Z79.891","N12.","M54.5","M54.12","M54.16","L25.8","Z79.52","M25.571","M25.572","R25.2","Z92.29","D84.9","M76.62","M67.872","S93.492A","I10.","E03.9","S73.192D","M70.61","Z80.41","D75.89","Z87.39","M47.816","M99.73","M43.17","M25.551"],"date":["2021-02-11","2020-06-15","2020-06-15","2020-02-09","2021-08-27","2020-02-12","2020-06-16","2021-11-09","2021-11-10","2021-11-10","2021-01-14","2021-07-03","2021-07-03","2021-07-03","2021-07-03","2021-07-03","2021-07-03","2021-07-03","2021-07-03","2021-08-04","2020-11-23","2021-06-03","2020-08-28","2021-11-09","2020-07-13","2021-06-03","2021-11-10","2020-11-10","2021-08-04","2021-08-04","2021-09-22","2020-05-20","2021-11-10","2020-06-03","2020-06-03","2021-06-01","2021-11-10","2021-11-10","2020-06-16","2020-06-16","2020-06-16","2021-11-09","2021-11-09","2021-02-23","2021-06-03","2020-04-06","2021-06-03","2021-07-03","2021-07-03","2021-07-03","2021-07-03","2021-06-23"],"priorHcc":["","","","","","","",null,null,null,"","","","","","","","","","","","","",null,"","",null,"","","","","",null,"","","",null,null,"","","",null,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":[["","67877044530","OLMESA","5MG","-60","Select","Select",""],["","65162062750","TRAMADOL","50MG","180","Select","Select",""],["","00781185220","AMOX\/K","875-125","20","Select","Select",""],["","69315012710","FOLIC","1000MCG","30","Select","Select",""],["","69238183107","LEVOTHYROXIN","50MCG","30","Select","Select",""],["","68180072003","AMLODIPINE","5MG","60","Select","Select",""],["","61703035038","METHOTREXATE","25MG\/ML","4","Select","Select",""],["","00093506101","HYDROXYZ","25MG","20","Select","Select",""],["","08290309623","1ML","27GX1\/2\"","-12","Select","Select",""],["","00074230630","RINVOQ","15MG ER","30","Select","Select",""],["","00406048410","APAP\/CODEINE","300-30MG","-14","Select","Select",""],["","13668008105","MONTELUKAST","10MG","90","Select","Select",""],["","00527293243","PREDNISONE","5MG","120","Select","Select",""],["","33342002332","LEVOFLOXACIN","750MG","5","Select","Select",""],["","00406012301","HYDROCO\/APAP","5-325MG","20","Select","Select",""],["","49281072010","FLUBLOK","2020-21","0","Select","Select",""],["","31722053301","METHOCARBAM","500MG","90","Select","Select",""],["","59267100003","PFIZER","COVID-19","0","Select","Select",""],["","67877044530","OLMESA ","TAB 5MG","-60","Select","Select",""],["","65162062750","TRAMADOL ","TAB 50MG","180","Select","Select",""],["","00781185220","AMOX\/K ","TAB 875-125","20","Select","Select",""],["","68180072003","AMLODIPINE ","TAB 5MG","60","Select","Select",""],["","61703035038","METHOTREXATE ","INJ 25MG\/ML","4","Select","Select",""],["","08290309623","1ML ","MIS 27GX1\/2\"","12","Select","Select",""],["","69315012710","FOLIC ","TAB 1000MCG","-30","Select","Select",""],["","69238183107","LEVOTHYROXIN ","TAB 50MCG","30","Select","Select",""],["","00093506101","HYDROXYZ ","TAB 25MG","20","Select","Select",""],["","00406048410","APAP\/CODEINE ","TAB 300-30MG","14","Select","Select",""],["","00074230630","RINVOQ ","TAB 15MG ER","30","Select","Select",""],["","13668008105","MONTELUKAST ","TAB 10MG","90","Select","Select",""],["","00527293243","PREDNISONE ","TAB 5MG","120","Select","Select",""],["","49281072010","FLUBLOK ","INJ 2020-21","0","Select","Select",""],["","33342002332","LEVOFLOXACIN ","TAB 750MG","5","Select","Select",""],["","00406012301","HYDROCO\/APAP ","TAB 5-325MG","30","Select","Select",""],["","31722053301","METHOCARBAM ","TAB 500MG","90","Select","Select",""],["","65862029490","ROSUVASTATIN ","TAB 10MG","90","Select","Select",""],["","59267100003","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":[[["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":""}]}]}