{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ERIN   K HURRY","gend":1,"add":"401 HARBOUR PATH","city":"VIRGINIA BEACH","state":"VA","zip":"23451-7130","dob":"1974-04-21","age":"","mstatus":"","insh":6872315,"cliId":"","pno":5408486861,"cno":5408486861,"email":"","ename":"","eno":"","pphy":"BAKHSHI, RAJA M","ppno":7573956900,"pcpadd":"303 35th St Ste 102, ","pcpcity":"Virginia Beach","pcpstate":"VA","pcpzip":234512868,"pcpcounty":"","pcpid":"","pcpname":"SENTARA FAMILY MEDICINE PHYSIC","ano":"","add2":"APT 206","add3":"","madd1":"401 HARBOUR PATH","madd2":"APT 206","madd3":"","mcity":"VIRGINIA BEACH","mstate":"VA","mzip":"23451-7130","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"TIDEWATER","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J45.50","J30.1","J30.89","I10","E78.2","E11.65","N18.9","R79.89","N71.9","R10.32","D27.9","J45.909","R06.09","R05","R06.2","R06.83","R40.0","G40.209","Z86.69","F41.9","Z91.89","R41.3","F43.23","F33.1","M47.816","M54.5","K80.20","H90.3","H93.293","J45.998","R56.9","F84.0","Z13.83","J02.9","J01.90","G40.409","H65.92","Z12.31","Z01.411","N93.8","L64.9","K64.5","R73.02","E55.9","R53.83","R10.9","Z77.120","G40.909","R73.9","R87.619","N91.1","K62.5","K76.0","R11.0","K59.09","D25.9","N91.2","N83.9","J98.4","J30.9","R07.9","Z01.419","Z11.51","Z11.3","T78.40XA","B44.9","E11.9","Z79.899","J45.20","J30.81","Z91.018","Z12.4","Z11.4","N83.8","J20.9","R07.89","R06.02","R50.9","Z88.1","R00.2"],"date":["2019-04-19","2020-10-07","2019-04-19","2020-10-29","2020-10-29","2020-10-29","2020-10-06","2020-10-29","2021-01-14","2021-01-14","2021-02-22","2021-04-01","2019-06-13","2019-06-13","2019-06-13","2019-06-13","2019-06-13","2019-09-18","2019-09-18","2019-09-18","2019-09-18","2019-09-18","2020-02-07","2020-02-07","2020-10-01","2020-10-02","2020-12-15","2020-10-07","2020-10-07","2021-04-12","2020-12-15","2020-10-07","2021-04-12","2019-04-08","2019-04-08","2019-04-08","2019-04-08","2019-07-17","2020-11-10","2019-08-09","2019-07-19","2019-07-19","2020-09-22","2020-09-22","2020-10-05","2020-10-22","2021-04-01","2019-05-20","2019-07-02","2019-08-09","2020-11-10","2020-12-15","2020-12-15","2020-12-15","2020-12-15","2021-01-20","2021-01-20","2021-01-20","2021-04-12","2019-03-12","2020-03-31","2020-11-10","2020-11-10","2020-11-10","2021-04-01","2021-04-01","2021-04-12","2021-04-12","2019-03-12","2019-03-12","2019-03-12","2019-07-02","2019-07-02","2019-07-31","2020-03-31","2020-03-31","2020-03-31","2020-03-31","2020-03-31","2021-01-20"],"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":[["","68180071160","CEFDINIR ","CAP 300MG","20","Select","Select",""],["","00143122701","DICYCLOMINE ","TAB 20MG","60","Select","Select",""],["","00591565810","CYCLOBENZAPR ","TAB 10MG","20","Select","Select",""],["","65862050320","AMOX\/K ","TAB 875-125","14","Select","Select",""],["","65862024608","LEVETIRACETA ","TAB 500MG","90","Select","Select",""],["","69097094312","GABAPENTIN ","CAP 300MG","30","Select","Select",""],["","53489011905","DOXYCYCL ","CAP 100MG","14","Select","Select",""],["","00378064010","PREDNISONE ","TAB 5MG","21","Select","Select",""],["","63304069301","CLINDAMYCIN ","CAP 300MG","21","Select","Select",""],["","70710113803","FLUCONAZOLE ","TAB 100MG","5","Select","Select",""],["","49502010202","EPINEPHRINE ","INJ 0.3MG","2","Select","Select",""],["","00555077902","MEDROXYPR ","TAB 10MG","5","Select","Select",""],["","68382075810","METFORMIN ","TAB 500MG","60","Select","Select",""],["","59310057922","PROAIR ","AER ","8.5","Select","Select",""],["","00186037020","SYMBICORT ","AER 160-4.5","10.2","Select","Select",""],["","00054327099","FLUTICASONE ","SPR 50MCG","16","Select","Select",""],["","33342020010","LEVOCETIRIZI ","TAB 5MG","30","Select","Select",""],["","53746010901","HYDROCO\/APAP ","TAB 5-325MG","12","Select","Select",""],["","65862041901","SMZ-TMP ","TAB 400-80MG","20","Select","Select",""],["","00093310905","AMOXICILLIN ","500MG","30","Select","Select",""],["","70377000612","ROSUVASTATIN ","5MG","30","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","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Yes","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":""}]}]}