{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KRISTA HUBBARD","gend":1,"add":"1208 SHELL ROAD","city":"HAMPTON","state":"VA","zip":"23661-9998","dob":"1986-01-31","age":"","mstatus":"","insh":"1143083*01","cliId":"","pno":"757\/977-7846","cno":"757\/977-7846","email":"","ename":"","eno":"","pphy":"CHINNERY, LIND MD","ppno":"757\/826-1600","pcpadd":"SUITE B 2100 EXECUTIVE DRIVE","pcpcity":"HAMPTON","pcpstate":"VA","pcpzip":23666,"pcpcounty":"","pcpid":174722,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/826-0160","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F31.81","J10.1","N30.00","B96.89","J02.0"],"date":["2020-01-03","2020-02-08","2020-02-08","2020-02-08","2020-02-08"],"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":[["","11822042030","SALINE ","0.65%","45","Select","Select",""],["","63402030230","LATUDA ","20MG","30","Select","Select",""],["","13668013705","ESCITALOPRAM ","20MG","30","Select","Select",""],["","50111044101","TRAZODONE ","150MG","15","Select","Select",""],["","00536408501","PRENATAL ","28-0.8MG","30","Select","Select",""],["","62332015190","OLM ","40-25MG","30","Select","Select",""],["","45802062626","CETIRIZINE ","1MG\/ML","100","Select","Select",""],["","64380073706","VITAMIN ","50000UNT","8","Select","Select",""],["","65862064163","AZITHROMYCIN ","250MG","6","Select","Select",""],["","00093075210","ATENOLOL ","50MG","30","Select","Select",""],["","68382059505","DILTIAZEM ","120MG ER","30","Select","Select",""],["","00781261305","AMOXICILLIN ","500MG","21","Select","Select",""],["","67877057301","BENZONATATE ","100MG","30","Select","Select",""],["","00143924920","AMOX\/K ","875-125","20","Select","Select",""],["","63402030230","LATUDA","20MG","30","Select","Select",""],["","13668013705","ESCITALOPRAM","20MG","30","Select","Select",""],["","50111044101","TRAZODONE","150MG","15","Select","Select",""],["","68382059505","DILTIAZEM","120MG ER","30","Select","Select",""],["","65862078190","OLM","40-25MG","30","Select","Select",""],["","00093075210","ATENOLOL","50MG","30","Select","Select",""],["","00781261305","AMOXICILLIN","500MG","21","Select","Select",""],["","67877057301","BENZONATATE","100MG","30","Select","Select",""],["","00536408501","PRENATAL","28-0.8MG","30","Select","Select",""],["","64380073706","VITAMIN","50000UNT","4","Select","Select",""],["","00143924920","AMOX\/K","875-125","20","Select","Select",""],["","65862064163","AZITHROMYCIN","250MG","6","Select","Select",""],["","45802062626","CETIRIZINE","1MG\/ML","100","Select","Select",""],["","11822042030","SALINE","0.65%","45","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","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["No","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":""}]}]}