{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"AUDREY   J SMILLIE-KIESCHNICK","gend":1,"add":"2688 W NECK ROAD","city":"VIRGINIA BEACH","state":"VA","zip":"23456-9998","dob":"1962-12-03","age":"","mstatus":"","insh":"6734626*01","cliId":"","pno":"757\/646-6786","cno":"757\/646-6786","email":"","ename":"","eno":"","pphy":"MANIAN, SWARNA MD","ppno":"000-0000","pcpadd":"1860 COLONIAL MEDICAL CT","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23454,"pcpcounty":"","pcpid":113694,"pcpname":"Va Beach Internal Medicine","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"486-4447","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/496-3822","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z12.39","M17.11","Z12.11","R92.2","Z01.419","M25.561","G89.29","H00.12","H04.123","Z13.820","Z12.31","H90.5","K13.21","Z00.00","H25.13","R92.8","E78.5","L30.9","L81.4","L82.1","D18.00","D22.9","Z12.83","Z71.9","L82.0","L57.8","M25.551","T65.91XA","T21.55XA","H40.013","E78.2","F41.1","F41.0","R52.","R22.31"],"date":["2021-03-12","2021-04-28","2021-08-30","2020-03-12","2021-03-12","2021-04-14","2021-04-14","2021-01-15","2021-07-30","2021-04-16","2021-02-04","2021-02-16","2020-05-14","2021-08-04","2021-07-30","2021-02-09","2020-06-10","2021-06-24","2021-06-24","2021-06-24","2021-06-24","2021-06-24","2021-06-24","2021-06-24","2021-06-24","2021-06-24","2020-05-19","2021-05-10","2021-05-10","2021-07-30","2021-08-04","2021-08-03","2021-08-03","2021-10-11","2021-10-11"],"priorHcc":["","",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":[["","65862090801","CELECOXIB","100MG","30","Select","Select",""],["","58160081912","SHINGRIX","50\/0.5ML","1","Select","Select",""],["","68382009905","PAROXETINE","30MG","90","Select","Select",""],["","00228202796","ALPRAZOLAM","0.25MG","30","Select","Select",""],["","33332032001","AFLURIA","2020-21","0","Select","Select",""],["","67877025115","TRIAMCINOLON","0.10%","15","Select","Select",""],["","68382009905","PAROXETINE ","30MG","90","Select","Select",""],["","65862090801","CELECOXIB ","100MG","30","Select","Select",""],["","58160081912","SHINGRIX ","50\/0.5ML","1","Select","Select",""],["","00228202796","ALPRAZOLAM ","0.25MG","30","Select","Select",""],["","33332032001","AFLURIA ","2020-21","0","Select","Select",""],["","67877025115","TRIAMCINOLON ","0.10%","15","Select","Select",""],["","49281042150","FLUZONE ","INJ 2021-22","0","Select","Select",""],["","59267100002","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":""}]}]}