{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"  HPESOJTTOCS W ","gend":0,"add":"EPPU 5061TC ELLIVR","city":"CHESAPEAKE","state":"VA","zip":"23321-9998","dob":"1959-12-07","pno":"64\/7573862-5","cno":"757\/465-2683","email":"","pphy":"STONE, KIMBERLY J MD","ppno":"","pcpadd":"SUITE 200 3253 TAYLOR RD","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":23321,"pcpcounty":"","pcpid":411053,"pcpname":"EAGLE HARBOR MEDICAL ASSOCIATES","insh":"1792110*37","cliId":"","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"757\/539-3446","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":["N28.9","N40.0","N28.89","Z01.818","E11.65","Z68.29","J44.9","J84.10","J98.4","R93.89","R91.1","I25.810","I10.","R10.84","F41.9","K59.00","I25.10","E11.9","G47.30","E78.00","I25.2","Z95.1","Z95.5","Z79.899","Z79.82","Z79.84","Z86.16","Z56.6","Z63.8","E78.49","Z00.00","K63.5","D12.0","Z86.010","S83.242A","R07.9","R91.8","Z01.89","S83.232A","M23.8X2","M22.3X2","U07.1","Z20.828","K21.9","Z12.11","Z13.9","Z01.810","I45.10","M94.8X6","M85.662","M25.562","I25.111","E78.5"],"date":["2021-09-17","2021-09-17","2021-09-17","2020-08-20","2021-03-16","2020-08-20","2021-09-07","2021-09-07","2021-09-07","2021-09-07","2021-09-07","2021-03-16","2021-03-16","2021-03-14","2021-03-16","2021-03-14","2021-03-14","2021-03-14","2021-03-14","2021-03-14","2021-03-14","2021-03-14","2021-03-14","2021-03-14","2021-03-14","2021-03-14","2021-03-14","2021-03-14","2021-03-14","2021-09-02","2021-09-02","2020-07-01","2020-07-01","2020-07-01","2020-08-28","2021-03-14","2021-03-14","2020-07-30","2020-08-28","2020-08-28","2020-08-28","2021-01-02","2020-12-23","2021-03-16","2021-03-16","2020-01-20","2020-08-20","2020-08-17","2020-07-16","2020-07-16","2020-07-16","2020-08-20","2020-08-20"],"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":[["","65862054890","VALSART\/HCTZ","160-12.5","30","Select","Select",""],["","65862039110","ONDANSETRON","8MG ODT","6","Select","Select",""],["","00406012301","HYDROCO\/APAP","5-325MG","10","Select","Select",""],["","68462026290","ROSUVASTATIN","10MG","30","Select","Select",""],["","00006027731","JANUVIA","100MG","30","Select","Select",""],["","00597015230","JARDIANCE","10MG","30","Select","Select",""],["","00093310953","AMOXICILLIN","500MG","21","Select","Select",""],["","00591090030","GLIPIZIDE","2.5MG","30","Select","Select",""],["","68382009301","CARVEDILOL","6.25MG","60","Select","Select",""],["","00116200116","CHLORHEX","0.12%","473","Select","Select",""],["","53885000810","ONETOUCH","PLUS 33G","100","Select","Select",""],["","51991070501","ALPRAZOLAM","0.5MG","90","Select","Select",""],["","49281042050","FLUZONE","2020-21","0","Select","Select",""],["","69097012705","AMLODIPINE","5MG","90","Select","Select",""],["","43547028110","ESCITALOPRAM","10MG","30","Select","Select",""],["","47781045601","NITROGLYCERN","0.3MG","100","Select","Select",""],["","68382041201","OMEPRAZOLE","20MG","90","Select","Select",""],["","65862054890","VALSART\/HCTZ ","TAB 160-12.5","30","Select","Select",""],["","00597015230","JARDIANCE ","TAB 10MG","30","Select","Select",""],["","31722094101","HYDROCO\/APAP ","TAB 5-325MG","10","Select","Select",""],["","00006027731","JANUVIA ","TAB 100MG","30","Select","Select",""],["","68382009301","CARVEDILOL ","TAB 6.25MG","60","Select","Select",""],["","65862039110","ONDANSETRON ","TAB 8MG ODT","6","Select","Select",""],["","00591090030","GLIPIZIDE ","TAB 2.5MG","30","Select","Select",""],["","68462026290","ROSUVASTATIN ","TAB 10MG","30","Select","Select",""],["","00093310953","AMOXICILLIN ","CAP 500MG","21","Select","Select",""],["","00116200116","CHLORHEX ","SOL 0.0012","473","Select","Select",""],["","53885027150","ONETOUCH ","TES VERIO","100","Select","Select",""],["","51991070501","ALPRAZOLAM ","TAB 0.5MG","90","Select","Select",""],["","49281042050","FLUZONE ","INJ 2020-21","0","Select","Select",""],["","69097012705","AMLODIPINE ","TAB 5MG","90","Select","Select",""],["","43547028110","ESCITALOPRAM ","TAB 10MG","30","Select","Select",""],["","47781045601","NITROGLYCERN ","SUB 0.3MG","100","Select","Select",""],["","68382041201","OMEPRAZOLE ","CAP 20MG","90","Select","Select",""],["","59267100002","PFIZER ","INJ COVID-19","0","Select","Select",""],["","58160088752","FLUARIX ","INJ 2021-22","0","Select","Select",""],["","58160082311","SHINGRIX ","INJ 50\/0.5ML","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":[[["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Yes","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":""}]}]}