{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DYLAN   B SLOANE","gend":1,"add":"241A MIDDLE LN APT A","city":"VIRGINIA BEACH","state":"VA","zip":"23454-9998","dob":"2003-09-23","age":"","mstatus":"","insh":"2084308*01","cliId":"","pno":"757\/802-8576","cno":"757\/802-8576","email":"","ename":"","eno":"","pphy":"REED, SHARON B MD","ppno":"757\/622-8358","pcpadd":"930 W 21ST ST SUITE 100","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23517,"pcpcounty":"","pcpid":156143,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R11.0","Z13.31","R10.33","R68.81","M25.50","NO DATA","Z82.61","M54.5","R53.81","G89.29","Z68.51","I95.1","M54.2","M54.9","K31.84","M25.561","R10.84","M25.571","L40.9","R21.","Z68.52","F32.3","F41.1","F41.0"],"date":["2020-09-11","2020-09-02","2020-09-02","2020-09-11","2020-05-12","2020-05-12","2020-05-12","2020-05-12","2020-05-12","2020-05-12","2020-05-12","2020-11-04","2020-11-04","2020-11-04","2020-11-04","2020-07-15","2020-07-15","2020-07-15","2021-03-16","2021-03-16","2021-03-16","2020-01-07","2020-01-07","2020-01-07"],"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":[["","16729017017","ESCITALOPRAM ","20MG","30","Select","Select",""],["","64380074107","BUSPIRONE ","5MG","60","Select","Select",""],["","65862039110","ONDANSETRON ","8MG ODT","90","Select","Select",""],["","69238147101","ERYTHROMYCIN ","250MG EC","90","Select","Select",""],["","00115703302","FLUDROCORT ","0.1MG","30","Select","Select",""],["","74312017621","D3 ","50MCG","90","Select","Select",""],["","52565003960","CLOBETASOL ","0.05%","60","Select","Select",""],["","51672135302","FLUOCINONIDE ","0.10%","30","Select","Select",""],["","59267100002","PFIZER ","COVID-19","0","Select","Select",""],["","00093005305","BUSPIRONE","5MG","60","Select","Select",""],["","16729017017","ESCITALOPRAM","20MG","30","Select","Select",""],["","00115703302","FLUDROCORT","0.1MG","30","Select","Select",""],["","65862039110","ONDANSETRON","8MG ODT","90","Select","Select",""],["","74312017621","D3","50MCG","90","Select","Select",""],["","24338012013","ERYTHROMYCIN","250MG EC","90","Select","Select",""],["","51672135302","FLUOCINONIDE","0.10%","30","Select","Select",""],["","52565003960","CLOBETASOL","0.05%","60","Select","Select",""],["","59267100002","PFIZER","COVID-19","0","Select","Select",""],["","55111012601","CIPROFLOXACN ","TAB 250MG","28","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":""}]}]}