{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"VERONICA   L COLON","gend":1,"add":"3704 WHITNEY CT","city":"VIRGINIA BEACH","state":"VA","zip":"23453-9998","dob":"1975-08-24","age":"","mstatus":"","insh":"2666928*01","cliId":"","pno":"757\/977-5147","cno":"757\/977-5147","email":"","ename":"","eno":"","pphy":"BHATTACHARYYA, BISWA MD","ppno":"757\/275-9331","pcpadd":"2088 S INDEPENDENCE BLVD STE #103","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23453,"pcpcounty":"","pcpid":172075,"pcpname":"Princess Anne Family Medicine","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"757\/785-7185","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/416-7656","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F41.1","F33.1","F41.0","S70.01XA","S86.911A","S83.91XA","M25.561","L98.9","Z11.1","N95.1","N39.3","N92.1","N80.0","R93.89","F17.210","Z01.419","Z12.39","K59.09"],"date":["2021-10-21","2020-11-11","2020-11-11","2020-01-19","2020-01-19","2020-01-23","2020-01-23","2021-04-28","2021-04-28","2020-03-16","2020-03-16","2020-03-16","2020-03-16","2020-03-16","2020-03-16","2020-02-17","2020-02-17","2020-02-17"],"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":[["","00378400305","ALPRAZOLAM ","0.5MG","60","Select","Select",""],["","65862037401","ESCITALOPRAM ","10MG","30","Select","Select",""],["","00378727253","NORETHINDRON ","0.35MG","28","Select","Select",""],["","11822003960","RA ","100MG","60","Select","Select",""],["","00046087221","PREMARIN ","0.625MG","30","Select","Select",""],["","52817033200","CYCLOBENZAPR ","10MG","30","Select","Select",""],["","63402030230","LATUDA ","20MG","30","Select","Select",""],["","64380080707","IBUPROFEN ","800MG","90","Select","Select",""],["","65862016001","ZOLPIDEM ","10MG","30","Select","Select",""],["","51672413001","LAMOTRIGINE ","25MG","44","Select","Select",""],["","68968345008","ESTRADIOL ","0.05MG","8","Select","Select",""],["","16714044104","SHAROBEL ","0.35MG","28","Select","Select",""],["","68462010340","FLUCONAZOLE ","150MG","2","Select","Select",""],["","69367016204","PHENAZOPYRID ","100MG","12","Select","Select",""],["","47781030301","NITROFURANTN ","100MG","14","Select","Select",""],["","68462079817","TRIAMCINOLON ","0.50%","30","Select","Select",""],["","63402030230","LATUDA","20MG","30","Select","Select",""],["","64380080707","IBUPROFEN","800MG","90","Select","Select",""],["","65862016001","ZOLPIDEM","10MG","30","Select","Select",""],["","00378400305","ALPRAZOLAM","0.5MG","60","Select","Select",""],["","52817033200","CYCLOBENZAPR","10MG","30","Select","Select",""],["","65862037401","ESCITALOPRAM","10MG","30","Select","Select",""],["","00046087221","PREMARIN","0.625MG","30","Select","Select",""],["","11822003960","RA","100MG","60","Select","Select",""],["","51672413001","LAMOTRIGINE","25MG","44","Select","Select",""],["","16714044104","SHAROBEL","0.35MG","28","Select","Select",""],["","00378727253","NORETHINDRON","0.35MG","84","Select","Select",""],["","69367016204","PHENAZOPYRID","100MG","12","Select","Select",""],["","47781030301","NITROFURANTN","100MG","14","Select","Select",""],["","68462010340","FLUCONAZOLE","150MG","2","Select","Select",""],["","68462079817","TRIAMCINOLON","0.50%","30","Select","Select",""],["","68968345008","ESTRADIOL","0.05MG","8","Select","Select",""],["","33342029907","ESZOPICLONE ","TAB 1MG","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":""}]}]}