{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LORI   L CAMDEN","gend":1,"add":"1296 HOLLY POINT RD","city":"VIRGINIA BEACH","state":"VA","zip":"23454-9998","dob":"1964-10-02","age":"","mstatus":"","insh":"6364349*02","cliId":"","pno":"757\/589-2344","cno":"757\/589-2344","email":"","ename":"","eno":"","pphy":"PHYSICIAN, PRIMARY CARE (MISC)","ppno":"","pcpadd":"4417 CORPORATION LN","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23462,"pcpcounty":"","pcpid":799999,"pcpname":"","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"757\/622-8100","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":["M35.3","M54.5","G89.29","A60.9","R30.9","N39.0","F32.9","D48.5","L82.1","B07.9","Z71.9","F32.0","M51.37","M47.816","M41.86","Z12.31","Z13.820","M85.80","M79.7","M70.61","M19.041","M19.042","R53.83","J06.9"],"date":["2020-07-21","2020-09-24","2020-09-24","2021-05-06","2021-05-06","2021-05-06","2021-05-06","2021-06-17","2021-07-01","2021-07-01","2021-07-01","2020-03-31","2020-07-21","2020-07-21","2020-07-21","2021-09-14","2020-09-24","2020-09-24","2021-06-24","2021-06-24","2021-06-24","2021-06-24","2021-09-17","2021-09-18"],"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":[["","65862019405","FLUOXETINE","40MG","90","Select","Select",""],["","31722070530","VALACYCLOVIR","1GM","30","Select","Select",""],["","49281042050","FLUZONE","2020-21","0","Select","Select",""],["","47781030301","NITROFURANTN","100MG","14","Select","Select",""],["","65862019405","FLUOXETINE ","40MG","30","Select","Select",""],["","31722070530","VALACYCLOVIR ","1GM","30","Select","Select",""],["","49281042050","FLUZONE ","2020-21","0","Select","Select",""],["","47781030301","NITROFURANTN ","100MG","14","Select","Select",""],["","58160082311","SHINGRIX ","50\/0.5ML","1","Select","Select",""],["","58160082311","SHINGRIX","50\/0.5ML","1","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":""}]}]}