{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JENNIFER   L GREEN","gend":1,"add":"343 MAPLE AVE","city":"NORFOLK","state":"VA","zip":"23503-9998","dob":"1984-04-05","age":"","mstatus":"","insh":"1702152*01","cliId":"","pno":"757\/343-8091","cno":"757\/343-8091","email":"","ename":"","eno":"","pphy":"FEE, ERIC MD","ppno":"757\/587-0157","pcpadd":"7924 CHESAPEAKE BLVD","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23518,"pcpcounty":"","pcpid":670139,"pcpname":"Bayview Medical Center","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/587-0074","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F43.12","F32.89","Z01.411","D25.1","N83.02","N93.9","F41.9","Z34.83","Z3A.28","O26.893","O36.0130","O34.211","Z3A.39","Z37.0","O99.344","F41.8","O99.334","F17.210","Z88.1","Z88.0","Z88.2","Z79.899","Z67.11","Z01.812","Z20.822","O09.523","H60.503","Z34.81","Z3A.08","Z32.02","R87.810","M54.89","O26.892","R51.9","Z3A.24","Z3A.31","Z23.","Z33.1","Z39.1","Z34.82","G89.18","H60.8X1","H66.91","L21.9","Z13.220","Z13.29","Z13.1","Z00.00","Z13.0","L98.9","Z28.21","Z68.26","Z01.419","Z11.51"],"date":["2020-12-15","2020-12-15","2020-06-17","2020-06-17","2020-06-17","2020-06-17","2020-08-17","2021-03-30","2021-01-13","2021-03-30","2021-01-13","2021-03-30","2021-03-30","2021-03-30","2021-03-30","2021-03-30","2021-03-30","2021-03-30","2021-03-30","2021-03-30","2021-03-30","2021-03-30","2021-03-30","2021-03-30","2021-03-30","2021-03-30","2021-07-02","2020-08-24","2020-08-24","2020-07-10","2020-07-10","2020-10-07","2020-12-18","2020-12-18","2020-12-18","2021-02-03","2021-02-03","2021-02-03","2021-02-17","2021-02-17","2021-03-31","2021-06-28","2021-06-28","2021-09-10","2021-09-10","2021-09-10","2021-09-10","2021-09-10","2021-09-10","2021-09-10","2021-09-10","2021-09-10","2021-09-10","2021-09-10"],"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":[["","65862052890","VENLAFAXINE ","75MG ER","30","Select","Select",""],["","00172392670","DIAZEPAM ","5MG","90","Select","Select",""],["","29300022701","METRONIDAZOL ","500MG","14","Select","Select",""],["","68462010340","FLUCONAZOLE ","150MG","2","Select","Select",""],["","10432003301","KPN ","","60","Select","Select",""],["","40985027384","PRENATAL ","200MG","30","Select","Select",""],["","69543025850","PREPLUS ","27-1MG","30","Select","Select",""],["","17478076710","PROGESTERONE ","200MG","10","Select","Select",""],["","11822308910","RA ","28-0.8MG","60","Select","Select",""],["","42192032130","PNV-DHA ","","30","Select","Select",""],["","11822382270","MICONAZOLE ","2%","7","Select","Select",""],["","11534018701","BUT\/APAP\/CAF ","","18","Select","Select",""],["","57896079101","SIMETHICONE ","80MG","30","Select","Select",""],["","42858010201","OXYCOD\/APAP ","5-325MG","18","Select","Select",""],["","65162046650","IBUPROFEN ","800MG","90","Select","Select",""],["","00904506860","MI-ACID ","80MG","30","Select","Select",""],["","62332025118","AZITHROMYCIN ","250MG","6","Select","Select",""],["","50383002505","OFLOXACIN ","0.3%OTIC","5","Select","Select",""],["","00781618667","CIPRO\/DEXA ","0.3-0.1%","8","Select","Select",""],["","58657067601","CIPROFLOXACN ","500MG","14","Select","Select",""],["","65862052890","VENLAFAXINE","75MG ER","30","Select","Select",""],["","00172392670","DIAZEPAM","5MG","90","Select","Select",""],["","29300022701","METRONIDAZOL","500MG","14","Select","Select",""],["","68462010340","FLUCONAZOLE","150MG","2","Select","Select",""],["","17478076710","PROGESTERONE","200MG","10","Select","Select",""],["","10432003301","KPN","","60","Select","Select",""],["","62107006301","PRENATAL","LOW IRON","60","Select","Select",""],["","11822308910","RA","28-0.8MG","60","Select","Select",""],["","42192032130","PNV-DHA","","30","Select","Select",""],["","69543025850","PREPLUS","27-1MG","30","Select","Select",""],["","11822382270","MICONAZOLE","2%","7","Select","Select",""],["","11534018701","BUT\/APAP\/CAF","","18","Select","Select",""],["","42858010201","OXYCOD\/APAP","5-325MG","18","Select","Select",""],["","65162046650","IBUPROFEN","800MG","90","Select","Select",""],["","00904506860","MI-ACID","80MG","30","Select","Select",""],["","57896079101","SIMETHICONE","80MG","30","Select","Select",""],["","62332025118","AZITHROMYCIN","250MG","6","Select","Select",""],["","50383002505","OFLOXACIN","0.3%OTIC","5","Select","Select",""],["","00781618667","CIPRO\/DEXA","0.3-0.1%","8","Select","Select",""],["","58657067601","CIPROFLOXACN","500MG","14","Select","Select",""],["","45802005535","TRIAMCINOLON","0.10%","30","Select","Select",""],["","45802005535","TRIAMCINOLON ","OIN 0.001","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":""}]}]}