{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"FARRAH A EFLAND","gend":1,"add":"772 W OCEAN VIEW AVE APT 1","city":"NORFOLK","state":"VA","zip":"23503-9998","dob":"1992-03-20","age":"","mstatus":"","insh":"2220684*01","cliId":"","pno":7577399343,"cno":7577399343,"email":"","ename":"","eno":"","pphy":"FEE, ERIC MD","ppno":7575870157,"pcpadd":"7924 CHESAPEAKE BLVD,","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":"23518-9998","pcpcounty":"","pcpid":"","pcpname":"Bayview Medical Center","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7575870074,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z20.822","J06.9","N30.01","Z71.1","F17.200","F11.10","Z72.0","F90.9","N39.0","F98.8","F32.9","NO DATA","Z00.00","K21.9","B18.2","Z51.81","Z01.419","Z11.3","N91.5","R10.2","N76.0","B96.89","B35.3","R10.30","N73.0","L21.9"],"date":["2021-07-26","2021-07-26","2021-07-26","2021-07-26","2021-07-26","2022-11-29","2022-11-29","2022-11-29","2022-04-05","2023-09-07","2023-09-07","2023-09-07","2022-03-09","2022-03-09","2021-03-01","2021-02-03","2021-02-09","2022-04-22","2021-02-09","2021-01-12","2021-01-12","2021-01-12","2021-01-12","2022-04-22","2022-04-22","2022-12-08"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","",""]}}]},{"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":[]},{"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":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","47781018001","AMPHET\/DEXTR","TAB 30MG","90","Select","Select",""],["","12496120803","SUBOXONE","MIS 8-2MG","36","Select","Select",""],["","00093216568","NALOXONE HCL","SPR ","2","Select","Select",""],["","16714043901","NITROFURANTN","CAP 100MG","10","Select","Select",""],["","68462011944","FLUCONAZOLE","TAB 150MG","2","Select","Select",""],["","69238110005","DOXYCYCL HYC","CAP 100MG","28","Select","Select",""],["","43598058230","BUPREN\/NALOX","MIS 8-2MG","14","Select","Select",""],["","16571066401","METRONIDAZOL","TAB 500MG","28","Select","Select",""],["","00093310953","AMOXICILLIN","CAP 500MG","32","Select","Select",""],["","63646001004","KETOCONAZOLE","SHA 0.02","120","Select","Select",""],["","42806034501","DEXTROAMPHETAMINE-AMPHETAMINE","30 MG","90","Select","Select",""],["","43598044874","NICOTINE PATCH","21 MG\/24HR","28","Select","Select",""]]}},{"a":[]},{"a":[]},{"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":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":[]}]},{"t":"Mini-Cog","q":[{"a":[]},{"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":"","a13":""}]}]}