{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BRITTNEY   A FELDER","gend":1,"add":"1716 CHESTWOOD DR","city":"VIRGINIA BEACH","state":"VA","zip":"23453-9998","dob":"1992-06-08","age":"","mstatus":"","insh":"20038187*01","cliId":"","pno":"757\/563-8574","cno":"757\/563-8574","email":"","ename":"","eno":"","pphy":"DONALDSON, NICOLE MD","ppno":"757\/227-6866","pcpadd":"SUITE 504 301 RIVERVIEW AVENUE","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23510,"pcpcounty":"","pcpid":161071,"pcpname":"Fort Norfolk Plaza Primary Care","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/277-0298","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K44.9","Z71.3","K21.9","M77.41","M77.42","M79.671","M79.672","J45.30","J30.89","T50.995A","Z00.00","Z13.1","Z13.220","Z13.29","Z13.21","E28.2","R45.1","H60.313","J45.20","D23.71","D23.72"],"date":["2020-10-28","2020-10-28","2020-10-28","2020-07-29","2020-07-29","2020-07-29","2020-07-29","2020-06-10","2021-05-26","2020-06-10","2020-10-29","2020-10-29","2020-10-29","2020-10-29","2020-10-29","2021-04-30","2021-04-30","2021-05-26","2021-05-26","2021-07-28","2021-07-28"],"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":[["","59746002022","RISPERIDONE ","1MG ODT","45","Select","Select",""],["","65628007010","FIRST-OMEPRA ","2MG\/ML","300","Select","Select",""],["","00006927531","SINGULAIR ","5MG","60","Select","Select",""],["","00430042014","LO ","10\/1\/10","28","Select","Select",""],["","50580064602","RHINOCORT ","ALLERGY","25","Select","Select",""],["","76204020025","ALBUTEROL ","0.08%","375","Select","Select",""],["","45802006003","BACITRACIN ","500\/GM","84","Select","Select",""],["","69315090510","LORAZEPAM ","1MG","4","Select","Select",""],["","00054485925","TRIAZOLAM ","0.25MG","4","Select","Select",""],["","59310057922","PROAIR ","","17","Select","Select",""],["","24208063110","NEO\/POLY\/HC ","1% OTIC","10","Select","Select",""],["","45802005536","TRIAMCINOLON ","0.10%","80","Select","Select",""],["","65628007010","FIRST-OMEPRA","2MG\/ML","600","Select","Select",""],["","59746002022","RISPERIDONE","1MG ODT","45","Select","Select",""],["","00430042014","LO","10\/1\/10","28","Select","Select",""],["","00006927531","SINGULAIR","5MG","60","Select","Select",""],["","50580064602","RHINOCORT","ALLERGY","8","Select","Select",""],["","76204020025","ALBUTEROL","0.08%","375","Select","Select",""],["","69315090405","LORAZEPAM","0.5MG","2","Select","Select",""],["","59310057922","PROAIR","","17","Select","Select",""],["","45802006003","BACITRACIN","500\/GM","84","Select","Select",""],["","24208063110","NEO\/POLY\/HC","1% OTIC","10","Select","Select",""],["","45802005536","TRIAMCINOLON","0.10%","80","Select","Select",""],["","00054485925","TRIAZOLAM","0.25MG","4","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","",""],["No","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":""}]}]}