{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JODY   M RAKER-EDMUNDS","gend":1,"add":"1421 GLENDALE AVE","city":"CHESAPEAKE","state":"VA","zip":"23323-9998","dob":"1978-03-23","age":"","mstatus":"","insh":"9672125*01","cliId":"","pno":"757\/752-7483","cno":"757\/752-7483","email":"","ename":"","eno":"","pphy":"ZHANG, DA MD","ppno":"757\/410-4488","pcpadd":"1024 S BATTLEFIELD BLVD","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":23320,"pcpcounty":"","pcpid":120527,"pcpname":"Hanbury Family Medicine","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/410-4450","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z00.00","Z12.31","Z20.828","R42.","K62.0","E55.9","M51.26","N94.6","R51.9","R11.0","J30.9","Z01.419","Z12.4","J01.00","M25.561","J01.90","N30.90","R50.9","M22.41","R60.0","M25.461","M79.89","M22.2X1","Z88.9"],"date":["2021-09-07","2021-02-15","2021-04-23","2021-09-07","2021-09-07","2021-09-07","2020-06-05","2021-01-05","2021-05-05","2021-04-19","2021-04-19","2020-12-07","2020-12-07","2021-09-10","2021-07-30","2020-05-12","2020-09-16","2020-12-14","2021-07-01","2021-07-01","2021-07-01","2021-07-01","2021-07-30","2021-09-10"],"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":[["","64380073706","VITAMIN","50000UNT","12","Select","Select",""],["","65862064163","AZITHROMYCIN","250MG","6","Select","Select",""],["","00135057602","FLONASE","50MCG","10","Select","Select",""],["","16714065202","CIPROFLOXACN","500MG","14","Select","Select",""],["","67877021620","CEFUROXIME","500MG","20","Select","Select",""],["","51293081101","PHENAZOPYRID","200MG","6","Select","Select",""],["","65162044210","MECLIZINE","25MG","30","Select","Select",""],["","60432026415","FLUTICASONE","50MCG","16","Select","Select",""],["","11534018701","BUT\/APAP\/CAF","","30","Select","Select",""],["","68462010340","FLUCONAZOLE","150MG","2","Select","Select",""],["","43598049501","NAPROXEN","550MG","40","Select","Select",""],["","60432026415","FLUTICASONE ","50MCG","16","Select","Select",""],["","00135057602","FLONASE ","50MCG","10","Select","Select",""],["","65862064163","AZITHROMYCIN ","250MG","6","Select","Select",""],["","64380073706","VITAMIN ","50000UNT","12","Select","Select",""],["","16714065202","CIPROFLOXACN ","500MG","14","Select","Select",""],["","51293081101","PHENAZOPYRID ","200MG","6","Select","Select",""],["","43598049501","NAPROXEN ","550MG","40","Select","Select",""],["","11534018701","BUT\/APAP\/CAF ","","30","Select","Select",""],["","59746012106","MECLIZINE ","25MG","-30","Select","Select",""],["","67877021620","CEFUROXIME ","500MG","20","Select","Select",""],["","68462010340","FLUCONAZOLE ","150MG","2","Select","Select",""],["","59746000103","METHYLPRED","4MG","21","Select","Select",""],["","59746000103","METHYLPRED ","TAB 4MG","21","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":""}]}]}