{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KAYLA   S SOLOMON","gend":1,"add":"5717 VOLSUNG CTS APT 201APT201","city":"VIRGINIA BEACH","state":"VA","zip":"23462-9998","dob":"1993-05-30","age":"","mstatus":"","insh":"2408589*01","cliId":"","pno":"757\/339-0263","cno":"757\/339-0263","email":"","ename":"","eno":"","pphy":"GRIFFIN, ALESIA W MD","ppno":"757\/366-0692","pcpadd":"1413 KEMPSVILLE RD","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":23320,"pcpcounty":"","pcpid":126262,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/366-9118","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F32.9","J30.9","J45.20","J45.31","G47.00","F31.0","F41.1","F51.01","I10.","R05.","K21.9","F31.2","F31.74","J45.909","N39.0","R53.83","N64.52","F31.9","V62.84","J06.9","K59.00"],"date":["2020-12-09","2020-10-09","2020-12-09","2020-10-09","2020-10-09","2021-04-19","2021-04-19","2021-04-19","2020-12-09","2020-11-22","2020-11-23","2020-11-25","2020-12-09","2020-11-23","2020-11-23","2020-11-21","2020-12-15","2020-12-15","2020-11-23","2020-11-23","2020-11-25"],"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":[["","00173071920","FLOVENT ","110MCG","12","Select","Select",""],["","00054327099","FLUTICASONE ","50MCG","16","Select","Select",""],["","45802008801","ALBUTEROL ","HFA","8","Select","Select",""],["","68645052254","SERTRALINE ","50MG","30","Select","Select",""],["","49035057139","ALLERGY ","180MG","30","Select","Select",""],["","29300022019","MONTELUKAST ","10MG","30","Select","Select",""],["","51862000706","MICROGESTIN ","Jan-20","63","Select","Select",""],["","49348096844","FEXOFENADINE ","180MG","30","Select","Select",""],["","49035036654","","","30","Select","Select",""],["","49884012401","LABETALOL ","300MG","60","Select","Select",""],["","00781286810","OMEPRAZOLE ","20MG","14","Select","Select",""],["","62756018488","OXCARBAZEPIN ","300MG","28","Select","Select",""],["","50742061610","METOPROL ","50MG ER","30","Select","Select",""],["","70700011985","ESTARYLLA ","0.25-35","84","Select","Select",""],["","64380080707","IBUPROFEN ","800MG","30","Select","Select",""],["","55111016730","OLANZAPINE ","15MG","30","Select","Select",""],["","62332002431","FLUOXETINE ","40MG","30","Select","Select",""],["","00143314250","DOXYCYCL ","100MG","14","Select","Select",""],["","50111043301","TRAZODONE ","50MG","30","Select","Select",""],["","59746017310","PREDNISONE ","10MG","10","Select","Select",""],["","68382032010","POT  CHLORIDE","10MEQ ER","14","Select","Select",""],["","00185061501","HYDROXYZ ","50MG","90","Select","Select",""],["","68682010610","NIFEDIPINE ","60MG ER","14","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","16729018201","HYDROCHLOROT ","12.5MG","30","Select","Select",""],["","10702000350","PROMETHAZINE ","25MG","12","Select","Select",""],["","65862077685","MILI ","0.25\/35","84","Select","Select",""],["","59762500801","MISOPROSTOL ","200MCG","4","Select","Select",""],["","49035078430","ALLERGY","180MG","30","Select","Select",""],["","68645052254","SERTRALINE","50MG","30","Select","Select",""],["","00173071920","FLOVENT","110MCG","12","Select","Select",""],["","51862000706","MICROGESTIN","Jan-20","63","Select","Select",""],["","00143980350","DOXYCYCL","100MG","14","Select","Select",""],["","50111043301","TRAZODONE","50MG","30","Select","Select",""],["","29300022019","MONTELUKAST","10MG","30","Select","Select",""],["","68382032010","POT CHLORIDE","10MEQ ER","14","Select","Select",""],["","00781286810","OMEPRAZOLE","20MG","14","Select","Select",""],["","62756018488","OXCARBAZEPIN","300MG","28","Select","Select",""],["","49884012401","LABETALOL","300MG","28","Select","Select",""],["","49348096844","FEXOFENADINE","180MG","30","Select","Select",""],["","68682010610","NIFEDIPINE","60MG ER","14","Select","Select",""],["","66993068530","OLANZAPINE","20MG","30","Select","Select",""],["","50742061610","METOPROL","50MG ER","30","Select","Select",""],["","00185061505","HYDROXYZ","50MG","30","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","68180096301","ALBUTEROL","HFA","8","Select","Select",""],["","62332002431","FLUOXETINE","40MG","30","Select","Select",""],["","16729018201","HYDROCHLOROT","12.5MG","30","Select","Select",""],["","10702000350","PROMETHAZINE","25MG","12","Select","Select",""],["","70700011985","ESTARYLLA","0.25-35","84","Select","Select",""],["","64380080707","IBUPROFEN","800MG","30","Select","Select",""],["","65862077685","MILI","0.25\/35","84","Select","Select",""],["","59762500801","MISOPROSTOL","200MCG","4","Select","Select",""],["","49281072110","FLUBLOK","2021-22","0","Select","Select",""],["","59267100001","PFIZER","COVID-19","0","Select","Select",""],["","00054327099","FLUTICASONE","50MCG","16","Select","Select",""],["","59746017310","PREDNISONE","10MG","10","Select","Select",""],["","59267100001","PFIZER ","INJ COVID-19","0","Select","Select",""],["","49281072110","FLUBLOK ","INJ 2021-22","0","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","",""],["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":""}]}]}