{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" ARDNASNIFFIRG","gend":1,"add":"LTSEN 4072LRT KOORBE","city":"VIRGINIA BEACH","state":"VA","zip":"23456-9998","dob":"1964-04-23","age":"","mstatus":"","insh":"9440210*71","cliId":"","pno":"27\/7570063-1","cno":"757\/721-3600","email":"","ename":"","eno":"","pphy":"KAMEL, NANCY MD","ppno":"757\/821-2088","pcpadd":"1232 PERIMETER PKWY SUITE 101","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23454,"pcpcounty":"","pcpid":188240,"pcpname":"TPMG CORPORATE LANDING INTERNAL FAM MEDICINE","plan":"OHP","program":"ACA","lob":"Individual","region":"TIDEWATER","aligned":"","ano":"757\/618-6555","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":["S82.122A","S82.132A","M17.11","M25.561","S82.142D","M25.562","J40.","R00.0","R11.0","J02.9","M79.10","R51.","R09.81","Z80.0","Z82.49","Z83.3","Z87.891","R07.89","N63.20","Z01.818","Z12.39","Z68.39","Z68.37","N39.0","S82.142A","N30.90","S82.161D","N63.22","M17.0","R41.0","Z87.19","Z93.3","Z90.49","Z98.890","Z80.8","M79.605","R07.9","R79.89","Z00.00","N63.0","B34.9","J32.9"],"date":["2020-04-06","2020-04-06","2020-07-08","2020-08-05","2020-07-06","2020-08-05","2020-03-09","2020-03-09","2020-03-09","2020-03-09","2020-03-09","2020-03-09","2020-03-09","2020-03-09","2020-04-06","2020-04-06","2020-04-06","2020-03-09","2021-07-28","2021-04-28","2021-04-28","2021-04-28","2020-07-13","2020-07-13","2020-04-06","2020-05-04","2020-05-04","2020-07-28","2020-08-05","2020-11-10","2020-04-06","2020-04-06","2020-04-06","2020-04-06","2020-04-06","2020-09-29","2021-04-28","2021-04-28","2021-04-28","2021-07-28","2021-10-07","2021-10-07"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",null,null]}},{"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":[["","00527169501","BUT\/APAP\/CAF","","20","Select","Select",""],["","00406012301","HYDROCO\/APAP","5-325MG","40","Select","Select",""],["","68382024705","BENZONATATE","100MG","30","Select","Select",""],["","13811071910","NITROFURANTN","100MG","20","Select","Select",""],["","68382004110","PROMETHAZINE","25MG","30","Select","Select",""],["","33342002208","LEVOFLOXACIN","500MG","7","Select","Select",""],["","88888888887","DMR","","1","Select","Select",""],["","69452015120","VITAMIN","50000UNT","12","Select","Select",""],["","00406051201","OXYCOD\/APAP","5-325MG","16","Select","Select",""],["","00173068220","VENTOLIN","","18","Select","Select",""],["","64380080707","IBUPROFEN","800MG","30","Select","Select",""],["","66993001968","ALBUTEROL","HFA","18","Select","Select",""],["","42571025101","CLINDAMYCIN","150MG","21","Select","Select",""],["","65862017601","PENICILLN","500MG","21","Select","Select",""],["","00054418425","DEXAMETHASON","4MG","5","Select","Select",""],["","00116200116","CHLORHEX","0.12%","473","Select","Select",""],["","66993001968","ALBUTEROL ","HFA","18","Select","Select",""],["","68382004110","PROMETHAZINE ","25MG","30","Select","Select",""],["","00527169501","BUT\/APAP\/CAF ","","20","Select","Select",""],["","00173068220","VENTOLIN ","","18","Select","Select",""],["","68382024705","BENZONATATE ","100MG","30","Select","Select",""],["","00406051201","OXYCOD\/APAP ","5-325MG","16","Select","Select",""],["","00406012301","HYDROCO\/APAP ","5-325MG","40","Select","Select",""],["","88888888887","DMR ","","1","Select","Select",""],["","33342002208","LEVOFLOXACIN ","500MG","7","Select","Select",""],["","13811071910","NITROFURANTN ","100MG","20","Select","Select",""],["","69452015120","VITAMIN ","50000UNT","12","Select","Select",""],["","42571025201","CLINDAMYCIN ","300MG","21","Select","Select",""],["","65862017601","PENICILLN ","500MG","21","Select","Select",""],["","00116200116","CHLORHEX ","0.12%","473","Select","Select",""],["","00054418425","DEXAMETHASON ","4MG","5","Select","Select",""],["","64380080707","IBUPROFEN ","800MG","30","Select","Select",""],["","23155013525","DOXYCYC","100MG","20","Select","Select",""],["","59267100002","PFIZER ","INJ COVID-19","0","Select","Select",""],["","23155013525","DOXYCYC ","TAB 100MG","20","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","",""],["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":""}]}]}