{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DESTINY  A LITTLE","gend":1,"add":"733 LINCOLN ST APT 3","city":"NORFOLK","state":"VA","zip":"23510-9998","dob":"1997-07-18","age":"","mstatus":"","insh":"3908860*01","cliId":"","pno":"757\/701-8253","cno":"757\/701-8253","email":"","ename":"","eno":"","pphy":"","ppno":"","pcpadd":"","pcpcity":"","pcpstate":"","pcpzip":"","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["O26.893","O99.89","R10.2","O99.013","D57.3","O99.830","F17.200","O34.83","N83.209","O99.513","J45.909","Z91.5","Z86.19","Z88.1","Z88.2","Z87.440","Z3A.37","O26.891","V23.87","Z72.0","O76.","F31.30","Z37.0","O99.324","O99.344","O99.52","O99.214","E66.01","Z3A.39","O99.62","K11.7","O77.0","F12.90","O99.824","O99.02","Z20.828","R10.9","N30.00","Z87.891","O36.8130","R10.31","R11.2","R10.84","R19.7","O20.8","Z3A.01","O28.8","O99.343","F32.9","O23.03","N10.","R74.0","O99.333","K64.4","R21.","F17.210","O21.9","O99.323","Z39.2","Z13.31","Z32.01","Z36.89","Z34.80","Z23."],"date":["2020-09-15","2020-09-15","2020-09-15","2020-09-15","2020-09-24","2020-09-15","2020-09-15","2020-09-15","2020-11-04","2020-09-15","2020-09-15","2020-09-15","2020-09-15","2020-09-15","2020-09-15","2020-09-15","2020-09-15","2020-03-17","2020-01-25","2020-01-25","2020-09-25","2020-09-24","2020-09-25","2020-09-24","2020-09-24","2020-09-24","2020-09-24","2020-09-24","2020-09-25","2020-09-24","2020-09-24","2020-09-24","2020-09-24","2020-09-24","2020-09-24","2020-09-24","2020-03-17","2020-03-17","2021-06-13","2020-09-10","2021-04-01","2021-04-01","2021-06-13","2021-06-13","2020-02-10","2020-02-10","2020-09-10","2020-09-10","2020-09-10","2020-09-10","2020-09-10","2020-09-10","2020-09-10","2020-09-30","2020-01-01","2020-01-01","2020-01-30","2020-09-25","2020-11-04","2020-11-04","2020-02-13","2020-02-13","2020-07-09","2020-07-09"],"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":[["","00713052612","PROMETHEGAN ","25MG","30","Select","Select",""],["","68462015713","ONDANSETRON ","4MG ODT","12","Select","Select",""],["","40985027288","VITAMIN ","5000UNIT","30","Select","Select",""],["","00093220401","METOCLOPRAM ","5MG","30","Select","Select",""],["","00172572860","FAMOTIDINE ","20MG","28","Select","Select",""],["","00093314705","CEPHALEXIN ","500MG","14","Select","Select",""],["","10702000350","PROMETHAZINE ","25MG","12","Select","Select",""],["","00591264001","BUT\/APAP\/CAF ","","20","Select","Select",""],["","00904585652","CALCIUM ","600MG","60","Select","Select",""],["","66424039901","STOOL ","100MG","7","Select","Select",""],["","00378210001","LOPERAMIDE ","2MG","30","Select","Select",""],["","37000045502","PRILOSEC ","20MG","42","Select","Select",""],["","00168000215","TRIAMCINOLON ","0.50%","15","Select","Select",""],["","63044015005","PRENATAL ","LOW IRON","30","Select","Select",""],["","00904759080","FEROSUL ","325MG","30","Select","Select",""],["","00904645760","DOK ","100MG","7","Select","Select",""],["","00378729253","NORETHINDRON ","0.35MG","28","Select","Select",""],["","65162046650","IBUPROFEN ","800MG","30","Select","Select",""],["","00185012201","NITROFURANTN ","100MG","10","Select","Select",""],["","42494030124","HYDROCORT ","25MG","30","Select","Select",""],["","65649041124","ANUSOL-HC ","25MG","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","",""],["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":""}]}]}