{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KHADIJA   A LANIER","gend":1,"add":"900 BAINBRIDGE BLVD UNIT B900","city":"NORFOLK","state":"VA","zip":"23523-9998","dob":"1979-09-05","age":"","mstatus":"","insh":"2666200*01","cliId":"","pno":"757\/738-9771","cno":"757\/738-9771","email":"","ename":"","eno":"","pphy":"LAYNE, MICHAEL MD","ppno":"757\/446-5955","pcpadd":"825 FAIRFAX AVE SUITE 118","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23507,"pcpcounty":"","pcpid":100070,"pcpname":"EVMS Ghent Family Medicine","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/446-5196","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R73.03","E66.9","J45.909","I10.","Z12.4","Z23."],"date":["2021-07-19","2021-07-19","2020-12-15","2020-12-15","2020-12-15","2020-12-15"],"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":[["","00904572872","ALLERGY ","10MG","30","Select","Select",""],["","00054327099","FLUTICASONE ","50MCG","16","Select","Select",""],["","65862001205","SERTRALINE ","50MG","30","Select","Select",""],["","70010049105","METFORMIN ","500MG ER","30","Select","Select",""],["","31722072610","MONTELUKAST ","10MG","30","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","00173088210","BREO ","200-25","60","Select","Select",""],["","65862006399","METOPROL ","50MG","60","Select","Select",""],["","66993058597","FLUTIC\/SALME ","250\/50","60","Select","Select",""],["","00173069600","ADVAIR ","250\/50","60","Select","Select",""],["","45802006405","TRIAMCINOLON ","0.10%","30","Select","Select",""],["","45802008801","ALBUTEROL ","HFA","8","Select","Select",""],["","16714089803","LORATADINE ","10MG","30","Select","Select",""],["","59267100001","PFIZER ","COVID-19","0","Select","Select",""],["","00054327099","FLUTICASONE","50MCG","16","Select","Select",""],["","65862001205","SERTRALINE","50MG","30","Select","Select",""],["","70010049105","METFORMIN","500MG ER","30","Select","Select",""],["","65862006399","METOPROL","50MG","60","Select","Select",""],["","31722072610","MONTELUKAST","10MG","30","Select","Select",""],["","00173069600","ADVAIR","250\/50","60","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","66993058597","FLUTIC\/SALME","250\/50","60","Select","Select",""],["","45802008801","ALBUTEROL","HFA","8","Select","Select",""],["","45802006405","TRIAMCINOLON","0.10%","30","Select","Select",""],["","00173088210","BREO","200-25","60","Select","Select",""],["","45802065087","LORATADINE","10MG","30","Select","Select",""],["","00904572872","ALLERGY","10MG","30","Select","Select",""],["","59267100001","PFIZER","COVID-19","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":""}]}]}