{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"WENDY   J SIMS","gend":1,"add":"2593 MULCH LANDING ROAD","city":"VIRGINIA BEACH","state":"VA","zip":"23453-9998","dob":"1953-07-13","pno":"757\/368-3722","cno":"757\/368-3722","email":"","pphy":"","ppno":"","pcpadd":"","pcpcity":"","pcpstate":"","pcpzip":"","pcpcounty":"","pcpid":"","pcpname":"","insh":"5786266*02","cliId":"","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"757\/407-4131","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":["Z20.818","Z00.00","R00.2","L91.8","L57.8","L82.1","Z12.83","L57.0","Z12.11","E78.5","F41.9","Z12.31","Z01.419","G47.00","Z12.12","Z13.820","H52.4","H25.13","H43.813","H21.541","M81.0","Z20.828","M85.80","M72.2","M79.641","G56.01","M65.331"],"date":["2020-06-30","2020-12-16","2020-12-09","2021-07-30","2021-07-30","2021-07-30","2021-07-30","2021-07-30","2021-08-30","2021-06-14","2021-06-14","2020-09-02","2020-09-14","2021-06-14","2020-09-15","2020-11-16","2020-12-14","2020-12-14","2020-12-14","2020-12-14","2020-06-30","2020-06-30","2020-12-09","2021-05-03","2021-05-05","2021-05-05","2021-05-05"],"priorHcc":["","","","","","","","",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":[["","00093005301","BUSPIRONE","5MG","60","Select","Select",""],["","00781106101","ALPRAZOLAM","0.25MG","30","Select","Select",""],["","59267100002","PFIZER","COVID-19","0","Select","Select",""],["","57237002901","AMOXICILLIN","875MG","20","Select","Select",""],["","00781106101","ALPRAZOLAM ","TAB 0.25MG","30","Select","Select",""],["","00093005301","BUSPIRONE ","TAB 5MG","60","Select","Select",""],["","59267100002","PFIZER ","INJ COVID-19","0","Select","Select",""],["","57237002901","AMOXICILLIN ","TAB 875MG","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","",""],["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":""}]}]}