{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BRIANNA   N JOHNSON","gend":1,"add":"215 MARCELLA RD APT 110","city":"HAMPTON","state":"VA","zip":"23666-9998","dob":"1999-07-02","age":"","mstatus":"","insh":"1434999*01","cliId":"","pno":"757\/305-7573","cno":"757\/305-7573","email":"","ename":"","eno":"","pphy":"MOTLEY, VICKIE MD","ppno":"757\/826-6889","pcpadd":"STE D 2200 EXECUTIVE DR","pcpcity":"HAMPTON","pcpstate":"VA","pcpzip":23666,"pcpcounty":"","pcpid":350384,"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":["O20.0","O03.9","Z3A.10","F32.0","Z11.1","O03.4","Z00.00","R09.81","Z30.40","E66.9","A59.09","Z3A.01","O20.9","Z3A.00","F32.9","Z30.09","Z23.","Z68.39"],"date":["2020-08-02","2020-08-08","2020-08-08","2020-11-10","2020-10-22","2020-08-08","2020-12-23","2020-12-23","2020-11-11","2021-08-23","2020-07-20","2020-07-20","2020-08-08","2020-08-08","2020-11-16","2020-11-16","2021-08-23","2021-08-23"],"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":[["","49483060450","IBUPROFEN ","800MG","50","Select","Select",""],["","47781030301","NITROFURANTN ","100MG","14","Select","Select",""],["","69452015120","VITAMIN ","50000UNT","12","Select","Select",""],["","50111033401","METRONIDAZOL ","500MG","14","Select","Select",""],["","59762453701","MEDROXYPR ","150MG\/ML","1","Select","Select",""],["","68682019050","CLINDAMY\/BEN ","1-5%","50","Select","Select",""],["","00555905058","KARIVA ","28 DAY","84","Select","Select",""],["","00093310905","AMOXICILLIN ","500MG","30","Select","Select",""],["","58160088552","FLUARIX ","2020-21","0","Select","Select",""],["","50111033401","METRONIDAZOL","500MG","14","Select","Select",""],["","69452015120","VITAMIN","50000UNT","12","Select","Select",""],["","47781030301","NITROFURANTN","100MG","14","Select","Select",""],["","67877032005","IBUPROFEN","600MG","30","Select","Select",""],["","68682019050","CLINDAMY\/BEN","1-5%","50","Select","Select",""],["","59762453701","MEDROXYPR","150MG\/ML","1","Select","Select",""],["","00555905058","KARIVA","28 DAY","84","Select","Select",""],["","58160088552","FLUARIX","2020-21","0","Select","Select",""],["","59267100001","PFIZER","COVID-19","0","Select","Select",""],["","57237000511","FLUCONAZOLE","150MG","2","Select","Select",""],["","00093310905","AMOXICILLIN","500MG","30","Select","Select",""],["","59267100001","PFIZER ","INJ COVID-19","0","Select","Select",""],["","57237000511","FLUCONAZOLE ","TAB 150MG","2","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":""}]}]}