{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DESTINY   A BARNES","gend":1,"add":"3004 TAIT TERRACE","city":"NORFOLK","state":"VA","zip":"23509-9998","dob":"1998-09-10","age":"","mstatus":"","insh":"2078307*01","cliId":"","pno":"757\/816-5612","cno":"757\/816-5612","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":"M4","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":["R55.","R51.9","N30.00","R10.9","R20.0","R20.2","Z78.9","Z68.42","A74.9","Z11.3","Z01.419","Z32.02","Z00.8","Z53.21","R87.615","R87.612"],"date":["2021-06-06","2021-06-06","2021-06-06","2020-05-27","2020-05-27","2020-05-27","2020-05-27","2020-05-27","2020-07-16","2020-07-16","2021-05-17","2021-08-06","2020-01-30","2020-01-30","2021-06-09","2021-08-06"],"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":[["","69238126601","OSELTAMIVIR ","75MG","10","Select","Select",""],["","68180016106","AZITHROMYCIN ","500MG","2","Select","Select",""],["","50111033401","METRONIDAZOL ","500MG","14","Select","Select",""],["","59267100002","PFIZER ","COVID-19","0","Select","Select",""],["","47781030301","NITROFURANTN ","100MG","10","Select","Select",""],["","68180012202","CEPHALEXIN ","500MG","28","Select","Select",""],["","31722063231","OSELTAMIVIR","75MG","10","Select","Select",""],["","68180016106","AZITHROMYCIN","500MG","2","Select","Select",""],["","50111033401","METRONIDAZOL","500MG","14","Select","Select",""],["","59267100002","PFIZER","COVID-19","0","Select","Select",""],["","47781030301","NITROFURANTN","100MG","10","Select","Select",""],["","68180012202","CEPHALEXIN","500MG","28","Select","Select",""],["","53489011905","DOXYCYCL ","CAP 100MG","14","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","",""],["N\/A","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":""}]}]}