{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"AROBEDEGNI H","gend":1,"add":" YAB 2161RD EZEERB","city":"VIRGINIA BEACH","state":"VA","zip":"23454-9998","dob":"1970-04-22","age":"","mstatus":"","insh":"6367920*72","cliId":"","pno":"84\/7576259-1","cno":"757\/615-7612","email":"","ename":"","eno":"","pphy":"GEORGE, LINDA J MD","ppno":"757\/962-6262","pcpadd":"STE A 1856 COLONIAL MED CT","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23454,"pcpcounty":"","pcpid":"","pcpname":"Trinity Medical Care PC","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":["G47.33","Z01.810","R19.00","Z12.31","F34.1","Z00.00","E55.9","M25.50","D22.30","Z20.822","M79.661","I87.2","J30.9","N80.1","K21.9","D25.1","E66.9","N39.3","G47.30","Z68.39","Z88.5","Z79.3","R10.30","Z01.419","R22.42","R60.9","M67.911","R76.8","M15.0","R89.9","R53.82","M25.512","M25.511","N83.202","S30.861A","S40.862A","S80.861A","Z71.9","Z28.21","H04.123","H16.223","Z71.3","N92.0","R92.8","L82.0","L60.8","Z00.01","Z68.41","M67.912","R19.04","S61.316A","N83.292","R05.","Z23.","I10.","Z01.818","S61.216A","M79.644","S61.316D","Z01.812","J44.9","L70.0","L71.9","L81.4","L57.8","L90.8","D22.9","D18.00","L91.8","Z12.83","J45.909","D31.32","R73.01","Z12.11","K63.5","K57.30"],"date":["2021-10-18","2019-06-26","2019-07-01","2020-10-21","2020-05-12","2021-12-03","2021-10-19","2020-12-04","2020-12-11","2021-10-09","2021-04-14","2019-04-03","2020-02-14","2019-07-01","2020-09-16","2019-07-01","2019-07-01","2019-07-01","2019-07-01","2021-12-07","2019-07-01","2019-07-01","2019-07-01","2021-01-05","2021-04-14","2021-04-14","2021-08-20","2021-10-19","2021-10-19","2021-10-19","2021-10-19","2021-12-09","2021-12-09","2019-07-01","2019-10-03","2019-10-03","2019-10-03","2020-06-30","2020-06-30","2021-02-15","2021-11-29","2021-09-29","2019-05-30","2019-10-22","2020-06-02","2020-06-02","2021-12-07","2020-12-03","2021-08-20","2019-06-04","2019-06-06","2019-07-01","2020-07-24","2020-10-13","2021-12-07","2019-06-26","2019-06-06","2019-06-06","2019-06-12","2019-06-26","2020-02-14","2020-06-30","2020-06-30","2020-06-30","2020-06-30","2020-06-30","2020-06-30","2020-06-30","2020-06-30","2020-06-30","2020-07-29","2021-11-29","2021-12-03","2021-03-23","2021-03-23","2021-03-23"],"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":[["","45802014167","CICLOPIROX","SOL 0.08","7","Select","Select",""],["","51267089099","CONTRAVE","TAB 8-90MG","120","Select","Select",""],["","00555902858","JUNEL","TAB 1.5\/30","112","Select","Select",""],["","65162057310","BETHANECHOL","TAB 25MG","3","Select","Select",""],["","42858010201","OXYCOD\/APAP","TAB 5-325MG","20","Select","Select",""],["","68180086613","BLISOVI","TAB 1.5\/30","112","Select","Select",""],["","61442010301","DICLOFENAC","TAB 75MG DR","30","Select","Select",""],["","45802026937","PERMETHRIN","CRE 0.05","60","Select","Select",""],["","00168000480","TRIAMCINOLON","CRE 0.001","80","Select","Select",""],["","68180098003","LISINOPRIL","TAB 10MG","30","Select","Select",""],["","51672416403","METRONIDAZOL","GEL 0.01","-60","Select","Select",""],["","00472011745","TRETINOIN","CRE 0.00025","-45","Select","Select",""],["","00115174801","METAXALONE","TAB 800MG","60","Select","Select",""],["","00574402435","ERYTHROMYCIN","OIN 5MG\/GM","4","Select","Select",""],["","00023916360","RESTASIS","EMU 0.0005","180","Select","Select",""],["","29300012510","MELOXICAM","TAB 15MG","90","Select","Select",""],["","68180051801","LISINOP\/HCTZ","TAB 10-12.5","30","Select","Select",""],["","00406012401","HYDROCO\/APAP","TAB 7.5-325","15","Select","Select",""],["","49281072110","FLUBLOK","INJ 2021-22","0","Select","Select",""],["","45802004475","ACYCLOVIR","CRE 0.05","5","Select","Select",""],["","70377005511","ESOMEPRA","CAP 20MG DR","90","Select","Select",""],["","42806071401","BENZONATATE","CAP 100MG","60","Select","Select",""],["","31722070590","VALACYCLOVIR","TAB 1GM","28","Select","Select",""],["","00781261305","AMOXICILLIN","CAP 500MG","30","Select","Select",""],["","69315090405","LORAZEPAM","TAB 0.5MG","4","Select","Select",""],["","59267100002","PFIZER","INJ COVID-19","0","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":""}]}]}