{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KELLI HOWERIN","gend":1,"add":"4409 JEANNE ST","city":"VIRGINIA BEACH","state":"VA","zip":"23462-9998","dob":"1959-11-29","age":"","mstatus":"","insh":"9504044*02","cliId":"","pno":"757\/671-8819","cno":"757\/671-8819","email":"","ename":"","eno":"","pphy":"AMABILE, ANTHONY T MD","ppno":"757\/464-2013","pcpadd":"816 INDEPENDENCE #G","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23455,"pcpcounty":"","pcpid":100628,"pcpname":"Bayside\/Amabile","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"671-8819","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":["D48.5","L57.0","L30.4","L85.3","D22.9","L81.4","L82.1","D18.01","Z87.898","Z12.83","Z71.9","I10.","E78.2","R73.02","F90.0","M19.032","R52.","I83.892","D22.5","Z23.","R94.31","M85.80","R53.83","Z13.820","Z12.31","Z78.0","E55.9","E11.9","Z00.01","M85.89","D64.9","Z12.11"],"date":["2020-06-04","2020-06-04","2020-06-04","2020-06-04","2020-06-04","2020-06-04","2020-06-04","2020-06-04","2020-06-04","2020-06-04","2020-06-04","2021-06-10","2021-09-02","2021-09-02","2020-07-14","2020-06-18","2020-06-18","2020-11-18","2020-06-04","2020-10-14","2021-03-12","2021-09-02","2021-09-02","2020-07-07","2020-07-07","2020-07-07","2020-12-10","2021-06-07","2020-12-15","2020-07-07","2021-09-02","2021-08-30"],"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":[["","58160081912","SHINGRIX","50MCG","1","Select","Select",""],["","42806004801","GUANFACINE","1MG","90","Select","Select",""],["","66993059902","AMPHET\/DEXTR","30MG ER","30","Select","Select",""],["","00005197105","PREVNAR","","0","Select","Select",""],["","00168009960","KETOCONAZOLE","2%","-60","Select","Select",""],["","69315090510","LORAZEPAM","1MG","1","Select","Select",""],["","55111012105","ATORVASTATIN","10MG","30","Select","Select",""],["","00378718505","METFORMIN","500MG","30","Select","Select",""],["","00093777179","RISEDRONATE","150MG","1","Select","Select",""],["","54092039101","ADDERALL","30MG","30","Select","Select",""],["","33332032001","AFLURIA","2020-21","0","Select","Select",""],["","00006483703","PNEUMOVAX","25\/0.5","0","Select","Select",""],["","00430047802","ACTONEL","150MG","3","Select","Select",""],["","00406051205","OXYCOD\/APAP","5-325MG","20","Select","Select",""],["","59676058005","JANSSEN","COVID-19","0","Select","Select",""],["","66993059902","AMPHET\/DEXTR ","30MG ER","30","Select","Select",""],["","58160081912","SHINGRIX ","50MCG","1","Select","Select",""],["","00006483703","PNEUMOVAX ","25\/0.5","0","Select","Select",""],["","42806004801","GUANFACINE ","1MG","90","Select","Select",""],["","00093321992","KETOCONAZOLE ","2%","60","Select","Select",""],["","00005197105","PREVNAR ","","0","Select","Select",""],["","55111012105","ATORVASTATIN ","10MG","30","Select","Select",""],["","33332032001","AFLURIA ","2020-21","0","Select","Select",""],["","00093777179","RISEDRONATE ","150MG","1","Select","Select",""],["","00591024105","LORAZEPAM ","1MG","-1","Select","Select",""],["","00378718505","METFORMIN ","500MG","30","Select","Select",""],["","00406051205","OXYCOD\/APAP ","5-325MG","20","Select","Select",""],["","54092039101","ADDERALL ","30MG","30","Select","Select",""],["","00430047802","ACTONEL ","150MG","3","Select","Select",""],["","59676058005","JANSSEN ","COVID-19","0","Select","Select",""],["","70461032103","FLUCLVX","2021-22","0","Select","Select",""],["","00093314705","CEPHALEXIN","500MG","30","Select","Select",""],["","65862001905","CEPHALEXIN ","CAP 500MG","30","Select","Select",""],["","70461032103","FLUCLVX ","INJ 2021-22","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":[[["Yes","Select","","","","","Select","",""],["Yes","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":""}]}]}