{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MELINDA   JEANENE SWAGER","gend":1,"add":"1337 GANNET RUN","city":"VIRGINIA BEACH","state":"VA","zip":"23451-9998","dob":"1973-05-29","pno":"757\/581-7469","cno":"757\/581-7469","email":"","pphy":"","ppno":"","pcpadd":"","pcpcity":"","pcpstate":"","pcpzip":"","pcpcounty":"","pcpid":"","pcpname":"","insh":"8325472*01","cliId":"","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":["D72.829","E78.00","F41.9","E66.3","Z32.02","D64.9","G43.909","G47.33","L57.0","H16.223","R53.83","R63.5","E34.9","R45.4","E55.9","Z00.01","Z00.00","L70.0","L71.9","L82.1","L81.4","D18.00","L57.8","D22.9","Z12.83","Z71.9","Z28.21","Z83.71","K57.30","K64.1","D53.9","N93.8","N85.2","J06.9","M25.511","Z12.31","Z01.419","Z11.51","M50.321","M54.2","Z23.","D75.89","R68.82","N95.1","E06.3","E03.9","Z12.11","M50.30","R03.0"],"date":["2021-01-19","2021-10-04","2021-10-04","2021-10-04","2021-01-19","2021-11-02","2020-02-24","2020-02-24","2021-05-10","2020-02-18","2020-06-30","2020-06-30","2020-10-01","2020-06-30","2020-06-30","2020-06-30","2021-06-15","2021-05-10","2021-01-20","2021-01-20","2020-01-20","2020-01-20","2021-05-10","2020-01-20","2020-01-20","2021-05-10","2020-01-20","2020-06-15","2020-06-15","2020-06-15","2021-11-09","2021-01-27","2021-01-27","2020-03-04","2020-07-20","2020-10-30","2021-03-16","2021-03-16","2020-06-25","2020-06-25","2021-10-04","2020-10-22","2021-09-29","2021-04-02","2021-04-02","2021-04-02","2020-03-26","2020-06-25","2021-10-04"],"priorHcc":["",null,null,null,"",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":[["","00023916330","RESTASIS","0.05%","-60","Select","Select",""],["","00591213155","AZELAIC","15%","-50","Select","Select",""],["","53746051401","SPIRONOLACT","50MG","30","Select","Select",""],["","67877057305","BENZONATATE","100MG","15","Select","Select",""],["","52268001201","SUPREP","PREP KIT","-354","Select","Select",""],["","52817033200","CYCLOBENZAPR","10MG","30","Select","Select",""],["","16729044416","BUPROPN","300MG XL","90","Select","Select",""],["","00456045801","ARMOUR","30MG","90","Select","Select",""],["","69452023420","PROGESTERONE","200MG","90","Select","Select",""],["","00378808445","TRETINOIN","0.10%","45","Select","Select",""],["","59267100001","PFIZER","COVID-19","0","Select","Select",""],["","42192032701","NP","15MG","-270","Select","Select",""],["","00093354143","ESTRADIOL","0.01%","-42","Select","Select",""],["","00023916360","RESTASIS ","EMU 0.0005","-60","Select","Select",""],["","53746051401","SPIRONOLACT ","TAB 50MG","30","Select","Select",""],["","00591213155","AZELAIC ","GEL 0.15","50","Select","Select",""],["","67877057305","BENZONATATE ","CAP 100MG","15","Select","Select",""],["","52268001201","SUPREP ","SOL PREP KIT","-354","Select","Select",""],["","68180032002","BUPROPN ","TAB 300MG XL","90","Select","Select",""],["","52817033200","CYCLOBENZAPR ","TAB 10MG","-30","Select","Select",""],["","00456045801","ARMOUR ","TAB 30MG","90","Select","Select",""],["","59651015301","PROGESTERONE ","CAP 200MG","-30","Select","Select",""],["","00378808445","TRETINOIN ","CRE 0.001","45","Select","Select",""],["","59267100001","PFIZER ","INJ COVID-19","0","Select","Select",""],["","42192032701","NP ","TAB 15MG","-15","Select","Select",""],["","00093354143","ESTRADIOL ","CRE 0.0001","42","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":""}]}]}