{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BINA   D CARR","gend":1,"add":"837 CAMBRIDGE DR","city":"VIRGINIA BEACH","state":"VA","zip":"23454-9998","dob":"1966-10-20","age":"","mstatus":"","insh":"20041668*01","cliId":"","pno":"757\/270-8746","cno":"757\/270-8746","email":"","ename":"","eno":"","pphy":"HAN, CAROLINE MD","ppno":"757\/301-7729","pcpadd":"813 INDEPENDENCE BLVD SUITE A","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23455,"pcpcounty":"","pcpid":175410,"pcpname":"ATLANTIC COAST FAMILY MEDICINE","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/301-7837","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M05.70","M06.9","R07.81","K12.1","E11.65","Z79.899","Z91.19","M65.832","M54.2","Z23.","E11.9","I10.","E78.5","E55.9","Z00.00","D47.3","H81.10","E61.1","Z01.419","Z12.39","R39.15","R59.1","Z68.25","D64.9","R01.1","G24.3","M06.88","R79.89","M05.79","M17.0","R51.9"],"date":["2021-11-01","2021-06-30","2021-05-10","2021-07-23","2021-11-04","2021-11-01","2021-11-01","2021-05-04","2020-06-25","2021-11-01","2020-03-06","2020-03-06","2021-08-04","2020-03-06","2020-03-06","2020-03-06","2020-03-06","2020-03-06","2021-04-22","2021-04-22","2021-04-22","2021-07-08","2021-07-08","2020-02-27","2020-03-16","2020-02-04","2020-02-04","2021-08-04","2021-10-28","2020-11-25","2021-11-04"],"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":[["","68382077501","METHOTREXATE ","2.5MG","32","Select","Select",""],["","67877044530","OLMESA ","5MG","30","Select","Select",""],["","69452015120","VITAMIN ","50000UNT","4","Select","Select",""],["","69315012710","FOLIC ","1000MCG","30","Select","Select",""],["","65862001005","METFORMIN ","1000MG","75","Select","Select",""],["","00006027731","JANUVIA ","100MG","30","Select","Select",""],["","10370074501","GLIPIZIDE ","5MG","60","Select","Select",""],["","00054327099","FLUTICASONE ","50MCG","16","Select","Select",""],["","29300012510","MELOXICAM ","15MG","30","Select","Select",""],["","00527293243","PREDNISONE ","5MG","30","Select","Select",""],["","59746012206","MECLIZINE ","12.5MG","60","Select","Select",""],["","59762010401","SULFASALAZIN ","500MG DR","180","Select","Select",""],["","65862029590","ROSUVASTATIN ","20MG","30","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","69543012010","ACARBOSE ","25MG","90","Select","Select",""],["","64980050924","DEXAMETHASON ","0.5\/5ML","280","Select","Select",""],["","00093317431","ALBUTEROL ","HFA","17","Select","Select",""],["","65162062750","TRAMADOL ","50MG","15","Select","Select",""],["","00363002401","ALLERGY ","50MCG","16","Select","Select",""],["","66689000816","NYSTATIN ","100000","250","Select","Select",""],["","67877044530","OLMESA","5MG","30","Select","Select",""],["","59762010401","SULFASALAZIN","500MG DR","60","Select","Select",""],["","68382077501","METHOTREXATE","2.5MG","32","Select","Select",""],["","29300012510","MELOXICAM","15MG","30","Select","Select",""],["","65862001005","METFORMIN","1000MG","75","Select","Select",""],["","00006027731","JANUVIA","100MG","30","Select","Select",""],["","10370074501","GLIPIZIDE","5MG","60","Select","Select",""],["","69452015120","VITAMIN","50000UNT","4","Select","Select",""],["","69315012710","FOLIC","1000MCG","30","Select","Select",""],["","00054472831","PREDNISONE","5MG","30","Select","Select",""],["","59746012206","MECLIZINE","12.5MG","60","Select","Select",""],["","65862029590","ROSUVASTATIN","20MG","30","Select","Select",""],["","00054327099","FLUTICASONE","50MCG","16","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","00093317431","ALBUTEROL","HFA","17","Select","Select",""],["","69543012010","ACARBOSE","25MG","90","Select","Select",""],["","65162062750","TRAMADOL","50MG","15","Select","Select",""],["","66689000816","NYSTATIN","100000","250","Select","Select",""],["","64980050924","DEXAMETHASON","0.5\/5ML","240","Select","Select",""],["","58160084252","BOOSTRIX","","0","Select","Select",""],["","00363002401","ALLERGY","50MCG","16","Select","Select",""],["","58160084252","BOOSTRIX ","INJ ","0","Select","Select",""],["","00186037220","SYMBICORT ","AER 80-4.5","10","Select","Select",""],["","00310737220","BUDES\/FORMOT ","AER 80-4.5","10","Select","Select",""],["","00527169501","BUT\/APAP\/CAF ","TAB ","90","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":""}]}]}