{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"VADA   T GUYNN","gend":1,"add":"828 MAYFIELD AVE","city":"NORFOLK","state":"VA","zip":"23518-9998","dob":"1965-12-27","age":"","mstatus":"","insh":"5970148*01","cliId":"","pno":"757\/729-0732","cno":"757\/729-0732","email":"","ename":"","eno":"","pphy":"FEE, ERIC MD","ppno":"757\/587-0157","pcpadd":"7924 CHESAPEAKE BLVD","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23518,"pcpcounty":"","pcpid":670139,"pcpname":"Bayview Medical Center","plan":"OHP","program":"ACA","lob":"Individual","region":"TIDEWATER","aligned":"","ano":"","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":["F33.0","F41.1","Z01.419","N95.2","M32.9","G89.4","D69.6","L82.1","D23.72","Z20.828","G43.019","M32.8","Z79.899","D69.3","R51.9","H25.13","Z00.00","Z12.31","M25.561","D18.01","L57.0","R53.83","G89.29","R42.","J01.90","M77.8","J01.00","J02.9","Z68.20","B34.9","Z12.11","Z23.","F41.9","G43.809","Z68.21","R35.0","G43.009","H81.11","J32.9"],"date":["2020-02-11","2020-02-11","2021-07-27","2020-02-06","2021-11-22","2021-11-22","2021-08-27","2021-01-18","2020-10-09","2020-12-29","2021-07-05","2021-05-03","2021-11-22","2021-11-22","2020-12-08","2021-05-03","2021-04-28","2021-10-26","2020-03-16","2021-01-18","2021-01-18","2021-04-28","2021-04-28","2021-10-11","2021-04-13","2021-06-04","2020-01-14","2020-01-14","2020-01-14","2020-12-29","2021-05-23","2021-11-22","2020-11-09","2020-11-09","2020-11-09","2021-11-03","2021-10-06","2021-10-06","2021-10-11"],"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":[["","69097083412","SERTRALINE","50MG","39","Select","Select",""],["","16729020201","BUSPIRONE","10MG","60","Select","Select",""],["","43386035701","HYDROCO\/APAP","7.5-325","60","Select","Select",""],["","50111043401","TRAZODONE","100MG","60","Select","Select",""],["","65862096701","ESZOPICLONE","1MG","30","Select","Select",""],["","43598072101","HYDROXYCHLOR","200MG","180","Select","Select",""],["","65162044210","MECLIZINE","25MG","40","Select","Select",""],["","10702001150","HYDROXYZ","25MG","60","Select","Select",""],["","00527133850","DOXYCYC","100MG","20","Select","Select",""],["","65862050220","AMOX\/K","500-125","20","Select","Select",""],["","00832105410","BACLOFEN","10MG","-30","Select","Select",""],["","00093310905","AMOXICILLIN","500MG","30","Select","Select",""],["","69097012203","TOPIRAMATE","25MG","360","Select","Select",""],["","59267100001","PFIZER","COVID-19","0","Select","Select",""],["","65162052110","PROMETHAZINE","25MG","20","Select","Select",""],["","67877026218","RIZATRIPTAN","10MG","10","Select","Select",""],["","69097083412","SERTRALINE ","50MG","39","Select","Select",""],["","65862096701","ESZOPICLONE ","1MG","30","Select","Select",""],["","16729028912","BUSPIRONE ","30MG","60","Select","Select",""],["","00527133850","DOXYCYC ","100MG","20","Select","Select",""],["","43386035701","HYDROCO\/APAP ","7.5-325","60","Select","Select",""],["","10702001150","HYDROXYZ ","25MG","-60","Select","Select",""],["","43598072101","HYDROXYCHLOR ","200MG","60","Select","Select",""],["","50111043401","TRAZODONE ","100MG","60","Select","Select",""],["","65862050220","AMOX\/K ","500-125","20","Select","Select",""],["","65162044210","MECLIZINE ","25MG","40","Select","Select",""],["","00093310905","AMOXICILLIN ","500MG","30","Select","Select",""],["","00832105410","BACLOFEN ","10MG","30","Select","Select",""],["","67877026218","RIZATRIPTAN ","10MG","10","Select","Select",""],["","69097012203","TOPIRAMATE ","25MG","120","Select","Select",""],["","59267100001","PFIZER ","COVID-19","0","Select","Select",""],["","65162052110","PROMETHAZINE ","25MG","20","Select","Select",""],["","70710122600","AMITRIPTYLIN","25MG","90","Select","Select",""],["","70710122600","AMITRIPTYLIN ","TAB 25MG","90","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":""}]}]}