{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JESSICA AVILA","gend":1,"add":"131 TOWER DR","city":"VIRGINIA BEACH","state":"VA","zip":"23462-9998","dob":"1979-04-09","age":"","mstatus":"","insh":"6160352*01","cliId":"","pno":"757\/770-1924","cno":"757\/770-1924","email":"","ename":"","eno":"","pphy":"LE, DAU T MD","ppno":"757\/671-8746","pcpadd":"SUITE 104 5444 VIRGINIA BEACH BLVD","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23462,"pcpcounty":"","pcpid":671359,"pcpname":"","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"757\/460-2401","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/363-8626","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R00.2","M54.42","S39.012A","Z13.220","R94.31","J20.9","Z12.31","Z13.1","Z00.00","I49.5","Z01.419","Z12.39"],"date":["2021-07-07","2020-02-17","2020-07-08","2021-06-21","2021-07-13","2021-07-07","2021-07-07","2021-07-07","2021-07-07","2021-07-27","2021-08-04","2021-08-04"],"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":[["","59746021106","CYCLOBENZAPR","5MG","30","Select","Select",""],["","59762444002","METHYLPRED","4MG","21","Select","Select",""],["","00406012301","HYDROCO\/APAP","5-325MG","25","Select","Select",""],["","68462019001","NAPROXEN","500MG","20","Select","Select",""],["","59762444002","METHYLPRED ","4MG","21","Select","Select",""],["","00406012301","HYDROCO\/APAP ","5-325MG","25","Select","Select",""],["","59746021106","CYCLOBENZAPR ","5MG","30","Select","Select",""],["","68462019001","NAPROXEN ","500MG","20","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","66993001968","ALBUTEROL ","HFA","18","Select","Select",""],["","50742061501","METOPROL ","25MG ER","90","Select","Select",""],["","57237002901","AMOXICILLIN ","875MG","20","Select","Select",""],["","64380071206","BENZONATATE ","100MG","30","Select","Select",""],["","64380073706","VITAMIN ","50000UNT","12","Select","Select",""],["","59746017506","PREDNISONE ","20MG","12","Select","Select",""],["","00121077516","GG\/CODEINE ","100-10\/5","240","Select","Select",""],["","57237002901","AMOXICILLIN","875MG","20","Select","Select",""],["","64380071206","BENZONATATE","100MG","30","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","66993001968","ALBUTEROL","HFA","18","Select","Select",""],["","59746017506","PREDNISONE","20MG","12","Select","Select",""],["","00121077516","GG\/CODEINE","100-10\/5","240","Select","Select",""],["","50742061501","METOPROL","25MG ER","90","Select","Select",""],["","64380073706","VITAMIN","50000UNT","12","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":""}]}]}