{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CRYSTAL COLOHAN","gend":1,"add":"2800 ALBANY CT","city":"VIRGINIA BEACH","state":"VA","zip":"23456-9998","dob":"1979-01-29","age":"","mstatus":"","insh":"8321183*01","cliId":"","pno":"757\/818-5270","cno":"757\/818-5270","email":"","ename":"","eno":"","pphy":"WADDELL, DAVID T MD","ppno":"757\/962-6262","pcpadd":"STE A 1856 COLONIAL MED CT","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23454,"pcpcounty":"","pcpid":143803,"pcpname":"Waddell Family Medicine PC","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"000\/000-0000","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":["I47.1","M47.819","M19.90","M46.1","M47.818","R04.0","D64.9","R06.02","Z20.822","I10.","Z91.048","R53.1","M54.5","G89.29","M51.16","M47.26","M54.10","M51.26","M47.816","M25.9","M53.3","M79.604","M25.50","M46.90","R06.00"],"date":["2021-05-27","2021-08-18","2021-06-18","2021-07-30","2021-06-18","2021-08-12","2021-08-12","2021-08-12","2021-08-12","2021-08-12","2021-08-12","2021-08-12","2021-08-18","2021-08-18","2021-07-30","2021-07-30","2021-07-30","2021-07-30","2021-07-30","2021-07-30","2021-07-30","2021-07-30","2021-07-30","2021-07-30","2021-08-12"],"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":[["","59762500005","SULFASALAZIN","500MG","20","Select","Select",""],["","00591024105","LORAZEPAM","1MG","30","Select","Select",""],["","55513084101","AIMOVIG","70MG\/ML","1","Select","Select",""],["","00093520006","BUSPIRONE","30MG","-180","Select","Select",""],["","00093719801","FLUOXETINE","40MG","90","Select","Select",""],["","59746000103","METHYLPRED","4MG","21","Select","Select",""],["","57237000299","HYDROCHLOROT","12.5MG","90","Select","Select",""],["","60505265301","TRAZODONE","50MG","180","Select","Select",""],["","70954005930","PREDNISONE","10MG","21","Select","Select",""],["","59762500005","SULFASALAZIN ","500MG","-360","Select","Select",""],["","00591024105","LORAZEPAM ","1MG","30","Select","Select",""],["","60505265301","TRAZODONE ","50MG","180","Select","Select",""],["","55513084101","AIMOVIG ","70MG\/ML","1","Select","Select",""],["","00093520006","BUSPIRONE ","30MG","-180","Select","Select",""],["","00093719801","FLUOXETINE ","40MG","90","Select","Select",""],["","59746000103","METHYLPRED ","4MG","21","Select","Select",""],["","57237000299","HYDROCHLOROT ","12.5MG","90","Select","Select",""],["","70954005930","PREDNISONE ","10MG","21","Select","Select",""],["","65862090901","CELECOXIB ","200MG","-60","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":""}]}]}