{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SANDRA REPASS","gend":1,"add":"1329 PINEVIEW AVE","city":"NORFOLK","state":"VA","zip":"23503-9998","dob":"1957-04-06","age":"","mstatus":"","insh":"20038321*01","cliId":"","pno":"480-1326","cno":"480-1326","email":"","ename":"","eno":"","pphy":"MACK, ALEXANDRA S MD","ppno":"757\/446-5955","pcpadd":"825 FAIRFAX AVE SUITE 118","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23507,"pcpcounty":"","pcpid":100070,"pcpname":"EVMS Ghent Family Medicine","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"714-2845","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/446-5196","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F43.23","M33.90","Z79.899","E55.9","K43.9","K43.6","H40.023","H04.123","H25.13","M32.9","D45.","K46.9","I10.","M25.511","E03.9","F90.2","H25.013"],"date":["2021-11-10","2021-07-12","2021-07-12","2021-07-12","2020-01-29","2020-02-03","2021-09-17","2021-09-17","2021-09-17","2021-09-17","2021-09-15","2020-03-02","2021-04-16","2021-03-29","2021-03-29","2021-08-11","2021-09-17"],"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":[["","60219107601","AZATHIOPRINE ","50MG","60","Select","Select",""],["","00173068220","VENTOLIN ","","18","Select","Select",""],["","59779027468","ASPIRIN ","81MG","30","Select","Select",""],["","23155000810","HYDROCHLOROT ","25MG","90","Select","Select",""],["","66993001968","ALBUTEROL ","HFA","18","Select","Select",""],["","00378180310","LEVOTHYROXIN ","50MCG","30","Select","Select",""],["","00093742698","MONTELUKAST ","10MG","90","Select","Select",""],["","00310737020","BUDES\/FORMOT ","160-4.5","10","Select","Select",""],["","68180072003","AMLODIPINE ","5MG","30","Select","Select",""],["","00054327099","FLUTICASONE ","50MCG","16","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","00186037020","SYMBICORT ","160-4.5","10","Select","Select",""],["","69097094312","GABAPENTIN ","300MG","60","Select","Select",""],["","80777027315","MODERNA ","COVID-19","0","Select","Select",""],["","60219107601","AZATHIOPRINE","50MG","60","Select","Select",""],["","00173068220","VENTOLIN","","18","Select","Select",""],["","59779027468","ASPIRIN","81MG","30","Select","Select",""],["","00378827052","ALBUTEROL","0.08%","150","Select","Select",""],["","00310737020","BUDES\/FORMOT","160-4.5","10","Select","Select",""],["","00054327099","FLUTICASONE","50MCG","16","Select","Select",""],["","23155000810","HYDROCHLOROT","25MG","30","Select","Select",""],["","68180072003","AMLODIPINE","5MG","30","Select","Select",""],["","00093742698","MONTELUKAST","10MG","30","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","00378180310","LEVOTHYROXIN","50MCG","30","Select","Select",""],["","00186037020","SYMBICORT","160-4.5","10","Select","Select",""],["","69097094312","GABAPENTIN","300MG","60","Select","Select",""],["","80777027310","MODERNA","COVID-19","0","Select","Select",""],["","70436000203","POT  CHLORIDE","TAB 10MEQ ER","30","Select","Select",""],["","45802065078","LORATADINE ","TAB 10MG","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","",""],["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":""}]}]}