{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KENISHA  L LAWRENCE","gend":1,"add":"6505 SORBY CT APT NONE","city":"NORFOLK","state":"VA","zip":"23513-9998","dob":"1984-02-12","age":"","mstatus":"","insh":"3685101*01","cliId":"","pno":"757\/748-9523","cno":"757\/748-9523","email":"","ename":"","eno":"","pphy":"FEE, ERIC MD","ppno":"757\/587-0157","pcpadd":"7924 CHESAPEAKE BLVD","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23518,"pcpcounty":"","pcpid":670139,"pcpname":"Bayview Medical Center","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/587-0074","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R51.9","R19.7","R05.","B34.9","NO DATA","Z20.828","M54.12","C50.919","Z00.00","Z23.","F33.1","R20.0","O03.9","K63.5","Z15.01","Z15.02","Z15.09","K04.7","M54.9","M25.571","K62.5","D12.6","Z33.1","M25.471","M76.891","Z03.818","R11.0","Z80.0","R30.0","D62.","O02.1","Z3A.08","O20.0","O20.8","Z3A.09","M47.816","M54.5","M19.071","N87.0","B97.7","M79.604","Q66.89","Z01.419","Z30.09","Z01.818","Z20.822","R94.31","G56.03","R10.84","R31.21","Z98.890","Z87.410","Z32.02","F31.9","Z3A.10","N64.4","N76.0","B37.3","Z11.3","Z11.4"],"date":["2020-10-09","2020-10-09","2020-10-09","2020-10-09","2020-10-09","2021-01-02","2020-11-20","2021-08-04","2020-12-17","2020-11-20","2021-06-29","2021-02-08","2021-04-12","2021-04-19","2021-04-19","2021-04-19","2021-04-19","2021-07-06","2021-07-06","2021-08-25","2021-01-07","2021-01-13","2021-03-10","2021-02-27","2021-02-27","2020-05-17","2020-05-17","2020-12-17","2020-12-17","2021-01-07","2021-04-02","2021-03-29","2021-04-06","2021-04-06","2021-04-06","2021-03-11","2021-03-11","2021-08-25","2021-03-10","2021-03-10","2021-08-25","2021-08-25","2020-12-30","2020-12-30","2021-01-02","2021-01-02","2021-01-02","2021-03-02","2020-09-12","2020-09-12","2020-11-23","2021-01-21","2021-01-21","2020-04-01","2021-04-02","2021-08-04","2021-07-27","2021-07-27","2021-07-27","2021-07-27"],"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":[["","67877032105","IBUPROFEN ","800MG","30","Select","Select",""],["","00378064110","PREDNISONE ","10MG","42","Select","Select",""],["","50428348640","GENTLE ","5MG EC","4","Select","Select",""],["","65862039010","ONDANSETRON ","4MG ODT","20","Select","Select",""],["","00574050810","FERROUS ","324MG","100","Select","Select",""],["","00143312610","DICYCLOMINE ","10MG","28","Select","Select",""],["","59779030602","CVS ","","238","Select","Select",""],["","81421002002","DULCOLAX ","5MG EC","4","Select","Select",""],["","00093310905","AMOXICILLIN ","500MG","21","Select","Select",""],["","29300022705","METRONIDAZOL ","500MG","14","Select","Select",""],["","42571016242","AMOX\/K ","875-125","20","Select","Select",""],["","68462010340","FLUCONAZOLE ","150MG","1","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":""}]}]}