{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"AARON   K ARCHER","gend":0,"add":"3543 DUNEDIN DR APT 104","city":"CHESAPEAKE","state":"VA","zip":"23321-9998","dob":"1989-12-11","age":"","mstatus":"","insh":"900038236*01","cliId":"4F44N51RY62","pno":"908\/507-3140","cno":"908\/507-3140","email":"","ename":"","eno":"","pphy":"SHEFFY, OHAD MD","ppno":"757\/538-7275","pcpadd":"SUITE 100 1540 BREEZEPORT WAY","pcpcity":"SUFFOLK","pcpstate":"VA","pcpzip":23435,"pcpcounty":"","pcpid":157508,"pcpname":"TPMG THE HEALTHY WAY FAMILY MEDICINE","plan":"OHP","program":"MEDICARE","lob":"MA-Non DSNP","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/335-7230","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R07.9","D57.00","D64.9","I10.","K21.9","J10.1","R52.","M87.059","G43.809","K52.9","R51.","R07.89","J20.9","Z76.5","Z20.828","N17.9","D57.219","M87.852","M87.851","Z88.1","Z88.0","Z91.19","E80.6","Z91.14","Z83.2","R50.81","R50.9","M87.051","M87.052","M87.859","K62.5","D57.1","Z00.00","Z13.1","H43.392","R91.8","R05.","M25.552","G44.209","Z04.1","K02.9","N48.30","M90.552","M90.551","E86.0","K80.20","E04.9","M16.0","Z86.2","K59.00","G47.00","M79.10","Z20.822","R39.16","Z79.899","Z88.8","Z79.891","R06.02","D57.419","N48.89","M54.40","L21.9","I26.99","J18.9","J98.11","F11.10","Z79.01","R07.81","D57.09","R00.0","M54.9","D58.2","R33.9","T40.605A","G62.9","M62.89","R09.82","R07.2","J90.","J18.1","Z45.2","Z86.711","H35.053","H40.013","I82.491","M87.9","M89.752","M89.751","H53.9","H53.8","B99.9","R10.11","D57.01","J96.01","I26.93","T38.0X5A","E87.6","F41.9","Z87.01","I86.1","G89.29","M25.50","R10.32","M79.652","M79.651","M25.562","M25.561","M25.551","J11.1","B02.9","D72.829","R09.02","G89.3","D57.20","B37.2","I26.09","E83.42","T14.90XA","R53.81","Z11.3","R14.2","R51.9","R03.0","N48.1","H93.90","M16.12","H43.813","R79.1","M87.08","M54.5","A41.9","M79.606","Y71.0","I27.82","R19.7","J84.10","R11.2","N48.32","R00.2","N48.9","R74.01","Z83.3","Z80.9","Z82.49","D57.819","R05.9"],"date":["2021-10-25","2021-10-25","2021-04-08","2021-07-28","2021-08-30","2020-02-06","2021-03-12","2020-11-30","2020-04-21","2020-06-15","2020-06-18","2021-08-24","2020-07-07","2021-04-07","2020-12-16","2020-07-18","2021-08-30","2021-08-30","2021-08-30","2021-08-30","2021-08-30","2020-07-11","2020-07-11","2021-04-07","2021-04-07","2020-07-11","2021-04-08","2021-08-31","2021-08-31","2020-09-28","2021-02-22","2021-11-22","2020-09-28","2020-09-28","2020-10-16","2021-04-04","2020-07-11","2021-10-25","2021-01-25","2020-03-07","2020-04-30","2021-08-30","2020-11-21","2020-11-21","2020-11-21","2021-08-11","2020-10-13","2020-12-01","2020-12-01","2021-03-19","2021-02-06","2021-01-25","2021-08-30","2021-01-25","2021-08-30","2021-01-25","2021-01-25","2021-08-29","2021-07-28","2021-08-02","2021-03-02","2021-02-23","2021-04-12","2021-04-08","2021-08-10","2021-03-26","2021-08-30","2021-04-07","2021-04-07","2021-04-07","2021-04-15","2021-11-22","2020-10-11","2020-10-11","2020-10-11","2020-10-11","2020-10-11","2021-02-03","2021-03-24","2021-03-24","2021-03-24","2021-08-30","2021-04-29","2021-04-29","2020-05-06","2021-03-19","2020-06-12","2020-06-12","2020-06-15","2020-06-13","2020-07-11","2020-11-28","2021-03-19","2021-03-19","2021-03-19","2021-03-19","2021-03-19","2021-08-30","2020-01-12","2020-01-24","2021-08-30","2020-02-29","2020-06-10","2020-07-02","2020-07-02","2021-04-15","2021-04-15","2021-10-25","2020-01-28","2020-11-12","2021-02-23","2021-03-29","2021-04-22","2021-04-29","2020-12-25","2021-03-23","2020-01-29","2020-03-07","2020-04-10","2020-09-28","2020-11-16","2021-08-17","2021-08-30","2021-01-06","2021-01-06","2020-01-29","2020-10-16","2020-05-06","2020-07-29","2021-08-11","2021-03-23","2021-07-28","2021-07-28","2021-08-11","2021-08-11","2021-08-10","2021-08-11","2021-09-02","2021-08-29","2021-08-31","2021-09-03","2021-08-30","2021-08-30","2021-08-30","2021-09-03","2021-10-12"],"priorHcc":[null,null,"",null,null,"","","","","","",null,"","","","",null,null,null,null,null,"","","","","","",null,null,"","",null,"","","","","",null,"","","",null,"","","","","","","","","","",null,"",null,"","",null,"","","","","","","","",null,"","","","",null,"","","","","","","","","",null,"","","","","","","","","","","","","","","",null,"","",null,"","","","","","",null,"","","","","","","","","","","","","",null,null,"","","","","","","","","","","","","",null,null,null,null,null,null,null,null,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":[["","042858010201","OXYCOD\/APAP ","5-325MG","28","Select","Select",""],["","065162046550","IBUPROFEN ","600MG","-20","Select","Select",""],["","065162019050","NAPROXEN ","500MG","40","Select","Select",""],["","055111015810","OMEPRAZOLE ","20MG","90","Select","Select",""],["","065162036111","FOLIC ","1MG","90","Select","Select",""],["","049884072401","HYDROXYUREA ","500MG","180","Select","Select",""],["","065862039010","ONDANSETRON ","4MG ODT","3","Select","Select",""],["","052959004304","DIPHENHYDRAM ","25MG","14","Select","Select",""],["","000093221001","SUCRALFATE ","1GM","-60","Select","Select",""],["","053746010901","HYDROCO\/APAP ","5-325MG","12","Select","Select",""],["","045802043803","HYDROCORT ","1%","28","Select","Select",""],["","042037010478","DEBROX ","6.5% OT","15","Select","Select",""],["","059779030501","CLOTRIMAZOLE ","1%","28","Select","Select",""],["","000574705012","BISACODYL ","10MG","30","Select","Select",""],["","050383079516","LACTULOSE ","10GM\/15","236","Select","Select",""],["","046581083006","SALONPAS ","4%","7","Select","Select",""],["","050458057990","XARELTO ","20MG","30","Select","Select",""],["","000003089421","ELIQUIS ","5MG","-60","Select","Select",""],["","010702005601","OXYCODONE ","10MG","90","Select","Select",""],["","061442011301","ACYCLOVIR ","800MG","25","Select","Select",""],["","050428028552","ACETAMINOPHN ","500MG","21","Select","Select",""],["","063187088515","ANTIFUNGAL ","2%","14","Select","Select",""],["","045802006335","TRIAMCINOLON ","0.03%","30","Select","Select",""],["","00536130485","DOCUSATE ","50MG\/5ML","473","Select","Select",""],["","65162046550","","600MG","20","Select","Select",""],["","65162046550","IBUPROFEN","600MG","20","Select","Select",""],["","42858010201","OXYCOD\/APAP","5-325MG","30","Select","Select",""],["","49884072401","HYDROXYUREA","500MG","180","Select","Select",""],["","65162036111","FOLIC","1MG","90","Select","Select",""],["","55111015810","OMEPRAZOLE","20MG","-90","Select","Select",""],["","65162019050","NAPROXEN","500MG","40","Select","Select",""],["","65862039010","ONDANSETRON","4MG ODT","3","Select","Select",""],["","53746010901","HYDROCO\/APAP","5-325MG","-12","Select","Select",""],["","63187088515","ANTIFUNGAL","2%","14","Select","Select",""],["","61442011301","ACYCLOVIR","800MG","25","Select","Select",""],["","45802006335","TRIAMCINOLON","0.03%","30","Select","Select",""],["","00093221001","SUCRALFATE","1GM","60","Select","Select",""],["","45802043803","HYDROCORT","1%","28","Select","Select",""],["","00574705012","BISACODYL","10MG","30","Select","Select",""],["","50383079516","LACTULOSE","10GM\/15","236","Select","Select",""],["","10702005601","OXYCODONE","10MG","20","Select","Select",""],["","00003089470","ELIQUIS","5MG","72","Select","Select",""],["","50458057990","XARELTO","20MG","-30","Select","Select",""],["","50428028552","ACETAMINOPHN","500MG","21","Select","Select",""],["","00093301756","TADALAFIL","5MG","30","Select","Select",""],["","00536130485","DOCUSATE","50MG\/5ML","473","Select","Select",""],["","52959004304","DIPHENHYDRAM","25MG","14","Select","Select",""],["","59779030501","CLOTRIMAZOLE","1%","28","Select","Select",""],["","42037010478","DEBROX","6.5% OT","15","Select","Select",""],["","46581083006","SALONPAS","4%","7","Select","Select",""],["","00093301756","TADALAFIL ","TAB 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":[[["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","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":""}]}]}