{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SELENNA   A HARRIS","gend":1,"add":"221 SHORE SIDE ROAD","city":"CHESAPEAKE","state":"VA","zip":"23320-9998","dob":"1974-04-08","age":"","mstatus":"","insh":"2660369*01","cliId":"","pno":"757\/343-4851","cno":"757\/343-4851","email":"","ename":"","eno":"","pphy":"REINEKE-PIPER, KRISTEN MD","ppno":"757\/488-3333","pcpadd":"3925 PORTSMOUTH BLVD","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":23321,"pcpcounty":"","pcpid":137859,"pcpname":"Family Medicine Health Care","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/488-0007","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N76.0","K08.89","R10.2","I10.","E11.9","B37.3","Z11.52","R11.2","L02.214","L03.314","E11.65","M54.5","V89.9XXA","L03.319","I48.91","F17.210","Z91.14","Z79.899","Z79.84","N76.4","J06.9","R05.","R06.2","S20.223A","B35.1","S90.31XA"],"date":["2020-02-25","2020-02-25","2020-12-18","2021-11-19","2021-11-19","2020-07-06","2021-01-20","2021-01-20","2020-01-27","2020-01-27","2020-01-27","2020-07-10","2020-07-10","2020-01-26","2020-01-26","2020-01-26","2020-01-26","2020-01-26","2020-01-26","2020-01-26","2021-07-11","2021-07-11","2021-07-11","2021-08-03","2021-08-03","2021-11-19"],"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":[["","68180072003","AMLODIPINE ","5MG","30","Select","Select",""],["","00085113204","PROVENTIL ","HFA","7","Select","Select",""],["","67877056110","METFORMIN ","500MG","30","Select","Select",""],["","00193737701","CONTOUR ","NEXT","1","Select","Select",""],["","56151146001","TRUE ","GLUCOSE","100","Select","Select",""],["","00254100752","ALBUTEROL ","HFA","7","Select","Select",""],["","53885065701","ONETOUCH ","VERIO","1","Select","Select",""],["","99073070805","FREESTYLE    MIS LITE","LITE","1","Select","Select",""],["","65702071210","ACCU-CHEK ","GUIDE","100","Select","Select",""],["","65862018601","CLINDAMYCIN ","300MG","21","Select","Select",""],["","99073070827","FREESTYLE    TES LITE","LITE","100","Select","Select",""],["","57237000511","FLUCONAZOLE ","150MG","2","Select","Select",""],["","64380080707","IBUPROFEN ","800MG","21","Select","Select",""],["","00363010412","PAIN ","325MG","20","Select","Select",""],["","08290326895","BD ","SNGL USE","100","Select","Select",""],["","00597015230","JARDIANCE ","10MG","30","Select","Select",""],["","52817033200","CYCLOBENZAPR ","10MG","21","Select","Select",""],["","65862039010","ONDANSETRON ","4MG ODT","10","Select","Select",""],["","00143211250","DOXYCYCL ","100MG","14","Select","Select",""],["","00054327099","FLUTICASONE ","50MCG","16","Select","Select",""],["","00187540008","JUBLIA ","10%","8","Select","Select",""],["","63824000832","MUCINEX ","600MG ER","15","Select","Select",""],["","00054001925","PREDNISONE ","50MG","5","Select","Select",""],["","16571020210","DICLOFENAC ","50MG DR","30","Select","Select",""],["","65162068090","PROMETHAZINE ","DM","118","Select","Select",""],["","23155010205","METFORMIN","500MG","30","Select","Select",""],["","68180072003","AMLODIPINE","5MG","30","Select","Select",""],["","00085113204","PROVENTIL","HFA","7","Select","Select",""],["","65862018601","CLINDAMYCIN","300MG","21","Select","Select",""],["","53885065701","ONETOUCH","VERIO","1","Select","Select",""],["","00193731221","CONTOUR","NEXT","100","Select","Select",""],["","56151146001","TRUE","GLUCOSE","100","Select","Select",""],["","99073070805","FREESTYLE MIS LITE","LITE","1","Select","Select",""],["","65702071210","ACCU-CHEK","GUIDE","100","Select","Select",""],["","00254100752","ALBUTEROL","HFA","7","Select","Select",""],["","99073070827","FREESTYLE TES LITE","LITE","100","Select","Select",""],["","57237000511","FLUCONAZOLE","150MG","2","Select","Select",""],["","00597015230","JARDIANCE","10MG","30","Select","Select",""],["","08290305488","BD","3.3QT","1","Select","Select",""],["","00363010412","PAIN","325MG","20","Select","Select",""],["","63824000832","MUCINEX","600MG ER","15","Select","Select",""],["","53489012002","DOXYCYCL","100MG","14","Select","Select",""],["","65862039010","ONDANSETRON","4MG ODT","10","Select","Select",""],["","00054327099","FLUTICASONE","50MCG","16","Select","Select",""],["","00187540008","JUBLIA","10%","8","Select","Select",""],["","65162068090","PROMETHAZINE","DM","118","Select","Select",""],["","16571020210","DICLOFENAC","50MG DR","30","Select","Select",""],["","00054001925","PREDNISONE","50MG","5","Select","Select",""],["","64380080707","IBUPROFEN","800MG","21","Select","Select",""],["","52817033200","CYCLOBENZAPR","10MG","21","Select","Select",""],["","68462056630","AMLOD\/OLMESA ","TAB 5-20MG","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","",""],["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":""}]}]}