{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CHRISTINE OYLER","gend":1,"add":"916 LAMBOURNE CT","city":"CHESAPEAKE","state":"VA","zip":"23322-9998","dob":"1986-05-26","age":"","mstatus":"","insh":"1220301*01","cliId":"","pno":"757\/434-8032","cno":"757\/434-8032","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":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/410-4450","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["S06.9X9A","S06.5X9A","I60.9","R90.89","J84.03","T68.XXXA","U07.1","S02.92XA","F41.9","F90.9","F32.9","S06.5X1A","V91.89XA","T75.1XXA","S06.6X9A","S02.19XA","S02.40FA","S02.85XA","F10.120","R00.1","H11.32","T46.5X5A","Z78.1","S06.309A","R40.2410","M54.30","R41.0","S09.90XA","S02.402A","S02.842A","F90.0","F32.1","R07.9","R41.82","T40.2X1A","R09.2","F17.210","Z79.899"],"date":["2020-12-31","2020-12-30","2020-12-30","2021-01-02","2020-12-30","2021-01-02","2021-01-02","2021-01-02","2021-11-22","2020-09-01","2020-10-05","2020-12-28","2020-12-28","2020-12-28","2021-01-02","2020-12-28","2020-12-28","2020-12-28","2020-12-28","2020-12-28","2020-12-28","2020-12-28","2020-12-28","2021-01-02","2020-12-28","2020-05-22","2020-12-28","2020-12-28","2021-02-05","2021-02-05","2021-09-20","2021-06-10","2020-12-31","2021-10-31","2021-10-31","2021-10-31","2021-10-31","2021-10-31"],"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":[["","00527150537","AMPHET\/DEXTR ","20MG","60","Select","Select",""],["","50111064801","FLUOXETINE ","20MG","30","Select","Select",""],["","51991070605","ALPRAZOLAM ","1MG","30","Select","Select",""],["","64380080707","IBUPROFEN ","800MG","20","Select","Select",""],["","65862001705","AMOXICILLIN ","500MG","21","Select","Select",""],["","69547035302","NARCAN ","","2","Select","Select",""],["","16571020150","DICLOFENAC ","75MG DR","20","Select","Select",""],["","52817033200","CYCLOBENZAPR ","10MG","30","Select","Select",""],["","00591544305","PREDNISONE ","20MG","18","Select","Select",""],["","59746011306","PROCHLORPER ","5MG","5","Select","Select",""],["","10702001850","OXYCODONE ","5MG","20","Select","Select",""],["","59267100001","PFIZER ","COVID-19","0","Select","Select",""],["","10702025350","BUT\/APAP\/CAF ","","12","Select","Select",""],["","00555901467","LESSINA ","","28","Select","Select",""],["","00527150537","AMPHET\/DEXTR","20MG","60","Select","Select",""],["","50111064801","FLUOXETINE","20MG","30","Select","Select",""],["","65862001705","AMOXICILLIN","500MG","21","Select","Select",""],["","64380080707","IBUPROFEN","800MG","20","Select","Select",""],["","51991070605","ALPRAZOLAM","1MG","30","Select","Select",""],["","00591544305","PREDNISONE","20MG","18","Select","Select",""],["","52817033200","CYCLOBENZAPR","10MG","30","Select","Select",""],["","16571020150","DICLOFENAC","75MG DR","20","Select","Select",""],["","10702001850","OXYCODONE","5MG","20","Select","Select",""],["","59746011306","PROCHLORPER","5MG","5","Select","Select",""],["","69547035302","NARCAN","","2","Select","Select",""],["","10702025350","BUT\/APAP\/CAF","","12","Select","Select",""],["","00555901467","LESSINA","","28","Select","Select",""],["","59267100001","PFIZER","COVID-19","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":[[["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":""}]}]}