{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LATASHA BROWN","gend":1,"add":"739 DOUGLAS AVE","city":"PORTSMOUTH","state":"VA","zip":"23707-9998","dob":"1981-02-10","pno":"757\/907-5665","cno":"757\/907-5665","email":"","pphy":"MAPANAO, VIVIAN MD","ppno":"","pcpadd":"Bridge Road Family Medicine 4868 Br","pcpcity":"SUFFOLK","pcpstate":"VA","pcpzip":23435,"pcpcounty":"","pcpid":138558,"pcpname":"Bridge Road Family Medicine","insh":"1346972*01","cliId":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"757\/394-5250","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/483-7150","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N92.0","Z68.44","D50.0","N39.0","R06.02","R00.0","J18.9","Z20.828","E88.81","M06.09","D50.9","Z79.899","R91.1","Z20.822","R07.9","D64.9","M05.70","J32.4","E66.01","R53.83","J01.00","R43.0","R43.2","H69.92","M54.9","I51.7","H66.001","Z23.","R30.0","J30.9","G47.33","Z87.891","Z82.49","Z83.3","M05.79","R32.","E66.9"],"date":["2021-05-25","2021-05-25","2021-09-01","2021-07-15","2021-09-04","2021-09-03","2021-09-04","2021-01-25","2021-01-31","2021-04-23","2021-04-23","2021-04-23","2021-08-25","2021-08-25","2021-08-30","2021-08-30","2021-08-30","2021-08-30","2021-09-03","2021-08-30","2021-01-25","2021-01-25","2021-01-25","2021-03-11","2021-09-03","2021-09-04","2020-10-29","2020-10-29","2021-04-23","2021-04-23","2021-09-03","2021-09-03","2021-09-03","2021-09-03","2021-09-30","2021-11-16","2021-11-16"],"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":[["","70710115803","LEFLUNOMIDE ","TAB 20MG","30","Select","Select",""],["","00904759080","FEROSUL ","TAB 325MG","180","Select","Select",""],["","53746027205","SMZ\/TMP ","TAB 800-160","6","Select","Select",""],["","59746000103","METHYLPRED ","TAB 4MG","21","Select","Select",""],["","00781808926","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","69238110005","DOXYCYCL ","CAP 100MG","20","Select","Select",""],["","00591505210","PREDNISONE ","TAB 5MG","20","Select","Select",""],["","11917009215","FERROUS ","TAB 325MG","180","Select","Select",""],["","00185012201","NITROFURANTN ","CAP 100MG","14","Select","Select",""],["","60846050201","PYRIDIUM ","TAB 200MG","6","Select","Select",""],["","59310057922","PROAIR ","AER ","26","Select","Select",""],["","51293061201","PHENAZOPYRID ","TAB 200MG","6","Select","Select",""],["","66993001968","ALBUTEROL ","AER HFA","18","Select","Select",""],["","31722072250","LEVOFLOXACIN ","TAB 500MG","5","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","",""],["Yes","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":""}]}]}