{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ANGELA CLARK","gend":1,"add":"3405 MAVERICK ST","city":"VIRGINIA BEACH","state":"VA","zip":"23452-9998","dob":"1964-05-08","age":"","mstatus":"","insh":"20000672*01","cliId":"","pno":"757\/609-5427","cno":"757\/609-5427","email":"","ename":"","eno":"","pphy":"SAN-MARINA, ANDREI MD","ppno":"757\/425-3610","pcpadd":"STE A 940 GENERAL BOOTH BLV","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23451,"pcpcounty":"","pcpid":153229,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/425-3625","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E89.0","Z98.84","N91.2","Z79.811","R03.0","D05.11","Z17.0","M54.16","M54.5","R25.2","Z79.891","S80.01XA","M70.51","E04.2","E03.9","Z13.220","M25.569","Z12.11","Z23.","E04.1","Z90.09","K91.2","I10.","Z85.3","Z86.711","M25.461","R00.0","Z68.29","S93.401A","D48.9","Z71.9","T14.8XXD","M79.89","R05.","J98.11","Z20.822","I49.9","Z87.891","Z86.19","Z86.718","R06.2","NO DATA"],"date":["2021-06-07","2021-09-15","2020-08-19","2020-08-19","2020-08-19","2021-03-05","2021-03-05","2021-05-27","2021-08-24","2021-05-27","2021-11-23","2021-06-03","2021-06-03","2020-01-02","2021-04-22","2021-04-22","2020-02-04","2021-03-29","2021-03-29","2020-01-02","2021-06-07","2021-06-07","2021-09-15","2021-06-07","2021-09-15","2021-06-07","2021-03-26","2021-03-26","2021-03-13","2021-08-17","2021-08-17","2021-08-24","2021-09-20","2021-09-15","2021-09-15","2021-09-15","2021-09-15","2021-09-15","2021-09-15","2021-09-15","2021-09-15","2021-11-23"],"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":[["","52817033200","CYCLOBENZAPR ","10MG","90","Select","Select",""],["","00115166001","PROPRANOLOL ","20MG","90","Select","Select",""],["","65162062711","TRAMADOL ","50MG","180","Select","Select",""],["","00456151060","SAVELLA ","100MG","60","Select","Select",""],["","00591352530","LIDOCAINE ","5%","30","Select","Select",""],["","00054429731","FUROSEMIDE ","20MG","30","Select","Select",""],["","16729003410","LETROZOLE ","2.5MG","30","Select","Select",""],["","24510011660","NUCYNTA ","100MG","60","Select","Select",""],["","69238183301","LEVOTHYROXIN ","88MCG","30","Select","Select",""],["","69547035302","NARCAN ","","2","Select","Select",""],["","00409178269","NALOXONE ","0.4MG\/ML","2","Select","Select",""],["","65862001705","AMOXICILLIN ","500MG","30","Select","Select",""],["","59267100002","PFIZER ","COVID-19","0","Select","Select",""],["","00093314705","CEPHALEXIN ","500MG","30","Select","Select",""],["","00406012305","HYDROCO\/APAP ","5-325MG","10","Select","Select",""],["","64380080807","IBUPROFEN ","600MG","90","Select","Select",""],["","65162062711","TRAMADOL","50MG","180","Select","Select",""],["","00456151060","SAVELLA","100MG","60","Select","Select",""],["","00115166001","PROPRANOLOL","20MG","90","Select","Select",""],["","24510011660","NUCYNTA","100MG","60","Select","Select",""],["","16729003410","LETROZOLE","2.5MG","30","Select","Select",""],["","52817033200","CYCLOBENZAPR","10MG","90","Select","Select",""],["","00591352530","LIDOCAINE","5%","30","Select","Select",""],["","00054429731","FUROSEMIDE","20MG","30","Select","Select",""],["","69238183301","LEVOTHYROXIN","88MCG","90","Select","Select",""],["","69547035302","NARCAN","","2","Select","Select",""],["","00409178269","NALOXONE","0.4MG\/ML","2","Select","Select",""],["","00093314705","CEPHALEXIN","500MG","30","Select","Select",""],["","65862001705","AMOXICILLIN","500MG","30","Select","Select",""],["","00406012305","HYDROCO\/APAP","5-325MG","10","Select","Select",""],["","64380080807","IBUPROFEN","600MG","90","Select","Select",""],["","59267100002","PFIZER","COVID-19","0","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","42806071401","BENZONATATE","100MG","30","Select","Select",""],["","69097014260","ALBUTEROL","HFA","7","Select","Select",""],["","59310057922","PROAIR ","AER ","8","Select","Select",""],["","69097014260","ALBUTEROL ","AER HFA","7","Select","Select",""],["","42806071401","BENZONATATE ","CAP 100MG","30","Select","Select",""],["","70461032103","FLUCLVX ","INJ 2021-22","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":[[["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Yes","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":""}]}]}