{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"STEPHANIE   M STEVENSON","gend":1,"add":"5113 BALLAHACK RD","city":"CHESAPEAKE","state":"VA","zip":"23322-9998","dob":"1987-10-10","age":"","mstatus":"","insh":"1560966*01","cliId":"","pno":"757\/525-6888","cno":"757\/525-6888","email":"","ename":"","eno":"","pphy":"WELLS, JANELLE M MD","ppno":"757\/393-6363","pcpadd":"664 LINCOLN ST","pcpcity":"PORTSMOUTH","pcpstate":"VA","pcpzip":23704,"pcpcounty":"","pcpid":102266,"pcpname":"Hampton Roads Community Health Center","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"757\/487-3458, ","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/397-0047","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F43.23","Z63.0","L20.82","L20.84","L85.3","Z01.419","Z12.4","N89.8","E55.9","R39.15","N80.3","L30.1","L28.0","H10.413","H16.223","R53.83","Z29.9","L50.9","F32.9","F41.9","J30.2","L40.9","E28.2","L30.9","R10.2"],"date":["2021-04-21","2021-03-25","2021-06-10","2021-06-10","2021-06-10","2021-02-23","2021-02-23","2021-02-23","2021-02-23","2021-02-23","2021-02-23","2020-12-22","2021-02-16","2020-11-24","2020-11-24","2021-05-04","2021-05-04","2020-05-21","2021-05-04","2021-05-04","2021-05-04","2021-05-04","2021-08-31","2021-05-04","2021-08-31"],"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":[["","00074003828","ORILISSA","150MG","28","Select","Select",""],["","45802005536","TRIAMCINOLON","0.10%","80","Select","Select",""],["","57664037718","TRAMADOL","50MG","120","Select","Select",""],["","68001019603","ESCITALOPRAM","10MG","30","Select","Select",""],["","00054455025","METHOTREXATE","2.5MG","32","Select","Select",""],["","00024591502","DUPIXENT","300\/2ML","2","Select","Select",""],["","68682011203","PIMECROLIMUS","1%","100","Select","Select",""],["","11788000110","FOLIC","1MG","30","Select","Select",""],["","69452015120","VITAMIN","50000UNT","12","Select","Select",""],["","65862052890","VENLAFAXINE","75MG ER","90","Select","Select",""],["","00168008016","HYDROCORT","2.50%","454","Select","Select",""],["","66993094748","CLOCORTOLONE","0.10%","45","Select","Select",""],["","00187001345","HYLATOPIC","PLUS","450","Select","Select",""],["","42546003010","HPR","","100","Select","Select",""],["","00591024110","LORAZEPAM","1MG","30","Select","Select",""],["","80777027399","MODERNA","COVID-19","0","Select","Select",""],["","00074003828","ORILISSA ","150MG","28","Select","Select",""],["","45802005536","TRIAMCINOLON ","0.10%","80","Select","Select",""],["","57664037718","TRAMADOL ","50MG","120","Select","Select",""],["","68001019603","ESCITALOPRAM ","10MG","30","Select","Select",""],["","00591024110","LORAZEPAM ","1MG","30","Select","Select",""],["","00024591502","DUPIXENT ","300\/2ML","4","Select","Select",""],["","00054455025","METHOTREXATE ","2.5MG","32","Select","Select",""],["","11788000110","FOLIC ","1MG","30","Select","Select",""],["","68682011203","PIMECROLIMUS ","1%","100","Select","Select",""],["","00187001345","HYLATOPIC ","PLUS","450","Select","Select",""],["","80777027399","MODERNA ","COVID-19","0","Select","Select",""],["","42546003010","HPR ","","100","Select","Select",""],["","69452015120","VITAMIN ","50000UNT","12","Select","Select",""],["","65862052890","VENLAFAXINE ","75MG ER","-90","Select","Select",""],["","00168008016","HYDROCORT ","2.50%","454","Select","Select",""],["","66993094748","CLOCORTOLONE ","0.10%","-45","Select","Select",""],["","67877032105","IBUPROFEN ","800MG","90","Select","Select",""],["","42858010250","OXYCOD\/APAP ","5-325MG","28","Select","Select",""],["","68180086473","BLISOVI ","FE 1\/20","84","Select","Select",""],["","67877032105","IBUPROFEN","800MG","90","Select","Select",""],["","68180086473","BLISOVI","FE 1\/20","84","Select","Select",""],["","42043041003","TERBINAFINE","250MG","90","Select","Select",""],["","42858010250","OXYCOD\/APAP","5-325MG","28","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","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","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":""}]}]}