{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TONI   A ANTHONY","gend":1,"add":"1420 HARDY CASH DR","city":"HAMPTON","state":"VA","zip":"23666-9998","dob":"1980-08-12","age":"","mstatus":"","insh":"2196825*01","cliId":"","pno":"757\/933-4712","cno":"757\/933-4712","email":"","ename":"","eno":"","pphy":"KARANDANA, KAMANI N MD","ppno":"757\/827-2025","pcpadd":"STE 300 4001 COLISEUM DR","pcpcity":"HAMPTON","pcpstate":"VA","pcpzip":23666,"pcpcounty":"","pcpid":700501,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/275-9802","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F90.2","F31.9","F43.11","F33.9","M54.81","K21.9","Z91.09","R05.","R10.13","Z23.","Z01.419","M54.16"],"date":["2020-11-13","2020-11-13","2020-11-13","2020-09-17","2020-12-04","2020-12-04","2020-12-04","2020-03-16","2020-10-20","2021-10-15","2021-11-04","2021-10-20"],"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":[["","00555097302","AMPHET\/DEXTR ","20MG","60","Select","Select",""],["","68180032002","BUPROPN ","300MG XL","30","Select","Select",""],["","00054327099","FLUTICASONE ","50MCG","48","Select","Select",""],["","00085113204","PROVENTIL ","HFA","7","Select","Select",""],["","00254100752","ALBUTEROL ","HFA","7","Select","Select",""],["","59746000103","METHYLPRED ","4MG","21","Select","Select",""],["","29300013510","CLONIDINE ","0.1MG","90","Select","Select",""],["","68462034690","LEVOCETIRIZI ","5MG","90","Select","Select",""],["","00591024005","LORAZEPAM ","0.5MG","60","Select","Select",""],["","62175011843","OMEPRAZOLE ","20MG","30","Select","Select",""],["","68180032002","BUPROPN","300MG XL","30","Select","Select",""],["","00555097302","AMPHET\/DEXTR","20MG","180","Select","Select",""],["","60505082901","FLUTICASONE","50MCG","48","Select","Select",""],["","00085113204","PROVENTIL","HFA","7","Select","Select",""],["","00254100752","ALBUTEROL","HFA","7","Select","Select",""],["","59746000103","METHYLPRED","4MG","21","Select","Select",""],["","68462034690","LEVOCETIRIZI","5MG","30","Select","Select",""],["","29300013510","CLONIDINE","0.1MG","30","Select","Select",""],["","00591024005","LORAZEPAM","0.5MG","60","Select","Select",""],["","62175011843","OMEPRAZOLE","20MG","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","",""],["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":""}]}]}