{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"  ANALIMYRREB G ","gend":1,"add":"BMAL 3101NL ENRUO","city":"VIRGINIA BEACH","state":"VA","zip":"23462-9998","dob":"1998-12-28","age":"","mstatus":"","insh":"0980130*01","cliId":"","pno":"73\/7570588-3","cno":"757\/373-8850","email":"","ename":"","eno":"","pphy":"BERTOLINO, SIOBHAN M MD","ppno":"757\/461-3890","pcpadd":"SUITE 208 844 KEMPSVILLE RD","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23502,"pcpcounty":"","pcpid":"","pcpname":"MAWC - Tidewater Physicians for Women","plan":"OHP","program":"ACA","lob":"Small Group","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":["F31.13","R10.2","N93.9","N94.10","Z32.02","F33.2","Z30.46","Z30.09","F31.9","Z20.2","N89.8","Z11.3","L70.0","L74.510","F60.3","Z01.812","Z11.59","J35.1","J03.91","R45.851","F32.9","J35.01","J45.909","Z86.59","F31.73","J03.90","R05.","R50.9","R63.0","R53.83","M79.10","Z20.828"],"date":["2021-12-02","2021-05-26","2021-05-26","2021-05-27","2021-05-26","2021-12-01","2021-01-15","2021-01-15","2021-01-15","2021-09-03","2021-09-03","2021-09-03","2019-08-07","2019-08-07","2019-10-21","2020-05-21","2020-09-30","2020-05-26","2020-05-26","2019-10-19","2019-10-19","2020-05-26","2020-05-26","2020-05-26","2020-02-14","2020-05-26","2020-09-30","2020-09-30","2020-09-30","2020-09-30","2020-09-30","2020-09-30"],"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":{"indx":[false,false],"comment":["",""],"score":["",""]}},{"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":[["","00093317431","ALBUTEROL","AER HFA","8","Select","Select",""],["","65862018730","ONDANSETRON","TAB 4MG","-30","Select","Select",""],["","00781185220","AMOX\/K","TAB 875-125","42","Select","Select",""],["","55111011230","MOXIFLOXACIN","TAB 400MG","21","Select","Select",""],["","57237004560","CLARITHROMYC","TAB 500MG","-28","Select","Select",""],["","00093101042","MUPIROCIN","OIN 0.02","22","Select","Select",""],["","70428001112","QBREXZA","PAD 0.024","30","Select","Select",""],["","00023520660","ACZONE","GEL 0.075","60","Select","Select",""],["","45802012801","CLINDAMYCIN","LOT 0.01","60","Select","Select",""],["","68180067711","OSELTAMIVIR","CAP 75MG","10","Select","Select",""],["","68180016013","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","70710113908","FLUCONAZOLE","TAB 150MG","10","Select","Select",""],["","00378064110","PREDNISONE","TAB 10MG","90","Select","Select",""],["","31722054501","LITHIUM","CAP 300MG","-180","Select","Select",""],["","00096070735","DRYSOL","SOL 0.2","35","Select","Select",""],["","53746051401","SPIRONOLACT","TAB 50MG","60","Select","Select",""],["","00406012301","HYDROCO\/APAP","TAB 5-325MG","50","Select","Select",""],["","14539067401","HYDROXYZ","CAP 25MG","60","Select","Select",""],["","13668011130","DULOXETINE","CAP 60MG","30","Select","Select",""],["","69315090405","LORAZEPAM","TAB 0.5MG","5","Select","Select",""],["","65862048901","QUETIAPINE","TAB 25MG","30","Select","Select",""],["","70436001102","BUPROPN","TAB 300MG XL","30","Select","Select",""],["","57664049983","MIRTAZAPINE","TAB 15MG","30","Select","Select",""],["","62332003731","LAMOTRIGINE","TAB 25MG","-90","Select","Select",""],["","51672404801","CLOTRIM\/BETA","CRE DIPROP","15","Select","Select",""],["","45802036862","IMIQUIMOD","CRE 0.05","12","Select","Select",""],["","45802058084","SCOPOLAMINE","DIS 1MG\/3DAY","5","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","21","Select","Select",""],["","00406051201","OXYCOD\/APAP","TAB 5-325MG","42","Select","Select",""],["","00093031401","KETOROLAC","TAB 10MG","20","Select","Select",""],["","50383004248","PREDNISOLONE","SOL 15MG\/5ML","180","Select","Select",""],["","49281042050","FLUZONE","INJ 2020-21","0","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","20","Select","Select",""],["","50111033401","METRONIDAZOL","TAB 500MG","30","Select","Select",""],["","00781618667","CIPRO\/DEXA","SUS 0.3-0.1%","8","Select","Select",""],["","80777027398","MODERNA","INJ COVID-19","0","Select","Select",""],["","16729020201","BUSPIRONE","TAB 10MG","60","Select","Select",""],["","00115165901","PROPRANOLOL","TAB 10MG","60","Select","Select",""],["","63402030230","LATUDA","TAB 20MG","14","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":""}]}]}