{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BEVERLY SMITH","gend":1,"add":"836 W 36TH ST APT 4","city":"NORFOLK","state":"VA","zip":"23508-9998","dob":"1946-05-30","age":"","mstatus":"","insh":"20035137*01","cliId":"","pno":"757\/701-4618","cno":"757\/701-4618","email":"","ename":"","eno":"","pphy":"NEWBY, JAMES E MD","ppno":"757\/627-6892","pcpadd":"STE 220 930 MAJESTIC AVE","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23504,"pcpcounty":"","pcpid":100347,"pcpname":"Primary Care Specialists","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/627-5809","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["H69.83","H92.03","L59.8","I10.","C02.9","Z86.73","J30.9","Z68.1","E46.","Z92.3","Z85.818","K11.7","Z85.89","I69.351","Z90.49","Z85.810","Z92.21","Z87.891","V58.89","I63.9","B18.2","K59.00","Z51.81","F17.200"],"date":["2020-05-14","2020-05-14","2020-06-01","2020-07-16","2020-07-16","2020-07-16","2020-07-16","2020-07-16","2020-07-22","2020-07-22","2020-07-22","2020-06-01","2020-06-01","2020-05-18","2020-05-18","2020-05-18","2020-05-18","2020-05-18","2020-05-18","2020-01-09","2020-01-15","2020-01-09","2020-01-15","2020-01-15"],"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":[["","45802091987","CETIRIZINE ","10MG","30","Select","Select",""],["","70377002811","ATORVASTATIN ","20MG","30","Select","Select",""],["","59779060027","CVS ","81MG EC","30","Select","Select",""],["","00536123441","ASPIRIN ","81MG EC","30","Select","Select",""],["","45802048678","DOCUSATE ","100MG","90","Select","Select",""],["","00093310905","AMOXICILLIN ","500MG","21","Select","Select",""],["","43386035701","HYDROCO\/APAP ","7.5-325","20","Select","Select",""],["","67877032005","IBUPROFEN ","600MG","20","Select","Select",""],["","68682010110","PENTOXIFYLLI ","400MG ER","60","Select","Select",""],["","00116200116","CHLORHEX ","0.12%","473","Select","Select",""],["","24208063562","NEO\/POLY\/HC ","1% OTIC","10","Select","Select",""],["","50428043890","VITAMIN ","1000UNIT","30","Select","Select",""],["","70461012003","FLUAD ","0.5ML","0","Select","Select",""],["","59676058015","JANSSEN ","COVID-19","0","Select","Select",""],["","45802048678","DOCUSATE","100MG","30","Select","Select",""],["","70377002811","ATORVASTATIN","20MG","30","Select","Select",""],["","59779060027","CVS","81MG EC","30","Select","Select",""],["","45802091987","CETIRIZINE","10MG","30","Select","Select",""],["","00093310905","AMOXICILLIN","500MG","21","Select","Select",""],["","43386035701","HYDROCO\/APAP","7.5-325","20","Select","Select",""],["","67877032005","IBUPROFEN","600MG","20","Select","Select",""],["","68682010110","PENTOXIFYLLI","400MG ER","60","Select","Select",""],["","50428043890","VITAMIN","1000UNIT","30","Select","Select",""],["","00116200116","CHLORHEX","0.12%","473","Select","Select",""],["","24208063562","NEO\/POLY\/HC","1% OTIC","10","Select","Select",""],["","00536123441","ASPIRIN","81MG EC","30","Select","Select",""],["","70461012003","FLUAD","0.5ML","0","Select","Select",""],["","59676058015","JANSSEN","COVID-19","0","Select","Select",""],["","49281012165","FLUZONE","2021-22","1","Select","Select",""],["","49281012165","FLUZONE ","INJ 2021-22","1","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","",""],["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":""}]}]}