{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KAYLIN CELESTINE","gend":1,"add":"300 WOODSTOCK ST","city":"PORTSMOUTH","state":"VA","zip":"23701-9998","dob":"2002-11-29","age":"","mstatus":"","insh":"1165035*01","cliId":"","pno":"757\/515-3082","cno":"757\/515-3082","email":"","ename":"","eno":"","pphy":"BURROWS, ADAYNA MD","ppno":"757\/962-8605","pcpadd":"1682 CHURCH STREET","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23504,"pcpcounty":"","pcpid":350008,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","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":["M41.124","M41.125","M54.9","R29.898","Z92.89","R26.9","M54.5","G89.29","Z11.3","M54.2","V43.52XA","Y92.810","Y93.89","M51.16","M21.371","Z91.19","B37.3","R35.0","R29.90","R89.9","N76.0","N30.01","Z71.89"],"date":["2021-02-10","2021-02-10","2021-02-10","2021-02-17","2021-02-17","2021-07-15","2021-05-10","2021-05-10","2021-02-04","2021-02-25","2021-02-25","2021-02-25","2021-02-25","2021-04-06","2020-12-23","2020-12-23","2020-12-06","2021-04-06","2020-12-31","2020-12-31","2020-12-27","2020-12-27","2020-12-27"],"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":[["","49502010202","EPINEPHRINE ","0.3MG","2","Select","Select",""],["","69452015120","VITAMIN ","50000UNT","12","Select","Select",""],["","57237007710","ONDANSETRON ","4MG ODT","12","Select","Select",""],["","00143980305","DOXYCYCL ","100MG","20","Select","Select",""],["","57237000511","FLUCONAZOLE ","150MG","1","Select","Select",""],["","80777027399","MODERNA ","COVID-19","0","Select","Select",""],["","49502010202","EPINEPHRINE","0.3MG","2","Select","Select",""],["","64380073706","VITAMIN","50000UNT","4","Select","Select",""],["","00143980305","DOXYCYCL","100MG","20","Select","Select",""],["","57237007710","ONDANSETRON","4MG ODT","12","Select","Select",""],["","57237000511","FLUCONAZOLE","150MG","1","Select","Select",""],["","80777027399","MODERNA","COVID-19","0","Select","Select",""],["","66993001968","ALBUTEROL ","AER HFA","18","Select","Select",""],["","59310057922","PROAIR ","AER ","8","Select","Select",""],["","63824007207","MUCINEX ","TAB 60-1200","10","Select","Select",""],["","00054418425","DEXAMETHASON ","TAB 4MG","4","Select","Select",""],["","29300022019","MONTELUKAST ","TAB 10MG","30","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":""}]}]}