{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"PATRICIA   A BINETTI","gend":1,"add":"937 IRON BRIDGE DR","city":"VIRGINIA BEACH","state":"VA","zip":"23462-9998","dob":"1950-09-19","age":"","mstatus":"","insh":"900043480*01","cliId":"9VA7GX1KW65","pno":"757\/472-0727","cno":"757\/472-0727","email":"","ename":"","eno":"","pphy":"PHYSICIAN, MR PRIMARY CARE MD","ppno":"","pcpadd":"4417 CORPORATION LANE","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23462,"pcpcounty":"","pcpid":"799MR","pcpname":"","plan":"OHP","program":"MEDICARE","lob":"MA-Non DSNP","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":["F10.20","H02.413","R35.0","S20.20XA","N39.0","G31.89","R90.82","R41.3","R23.8","Z20.822","J30.1","R05.","K21.9","R49.0","K57.30","Z86.010","R07.81","R41.840","Z12.31","E03.9","M25.511","F10.239","G62.9","I10.","G89.29","M54.9","B30.3","Z98.84","N32.81","H11.32","R51.9","M25.561","M25.562","F10.10","M54.2","S09.90XA","M25.552","T14.90XA","Z01.818","M75.101","E66.9","K21.00","G62.89","G61.82","N39.3","F10.21","R91.1","Z68.35","R91.8","J84.10","S09.92XD","Z86.79","Z12.11"],"date":["2021-08-04","2021-03-04","2021-03-17","2021-03-17","2021-03-17","2021-04-12","2021-04-12","2021-04-12","2021-05-13","2021-02-06","2021-05-14","2021-08-18","2021-04-15","2021-03-19","2021-03-16","2021-03-16","2021-03-19","2021-03-19","2021-06-01","2021-02-24","2021-04-06","2021-01-05","2021-01-05","2021-02-24","2021-01-05","2021-01-05","2021-01-05","2021-01-05","2021-01-05","2021-01-18","2021-01-18","2021-01-18","2021-01-18","2021-03-08","2021-01-15","2021-01-15","2021-01-15","2021-01-15","2021-02-02","2021-02-02","2021-02-02","2021-02-24","2021-02-24","2021-02-24","2021-02-24","2021-02-24","2021-04-05","2021-02-24","2021-04-05","2021-04-05","2021-04-15","2021-01-15","2021-05-23"],"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":[["","65162037110","OXYBUTYNIN ","5MG ER","42","Select","Select",""],["","65862085999","FAMOTIDINE ","20MG","180","Select","Select",""],["","00536106229","STOOL ","100MG","28","Select","Select",""],["","42192032701","NP ","15MG","90","Select","Select",""],["","65757030001","VIVITROL ","380MG","-1","Select","Select",""],["","57237001999","DULOXETINE ","60MG","180","Select","Select",""],["","69238131509","PREGABALIN ","200MG","180","Select","Select",""],["","65862042001","SMZ\/TMP ","800-160","6","Select","Select",""],["","65162062750","TRAMADOL ","50MG","14","Select","Select",""],["","61314063136","NEO\/POLY\/DEX ","0.1% OP","4","Select","Select",""],["","30142030602","GENTLELAX ","","238","Select","Select",""],["","55111064505","OMEPRAZOLE ","40MG","90","Select","Select",""],["","70710122601","AMITRIPTYLIN ","25MG","21","Select","Select",""],["","16729018317","HYDROCHLOROT ","25MG","90","Select","Select",""],["","00591352530","LIDOCAINE ","5%","30","Select","Select",""],["","29300012501","MELOXICAM ","15MG","30","Select","Select",""],["","59267100002","PFIZER ","COVID-19","0","Select","Select",""],["","45802065078","LORATADINE ","10MG","90","Select","Select",""],["","058160082311","SHINGRIX ","50\/0.5ML","1","Select","Select",""],["","52268020101","SUTAB ","","24","Select","Select",""],["","00527293341","PREDNISONE ","10MG","30","Select","Select",""],["","65862085999","","20MG","180","Select","Select",""],["","65862085999","FAMOTIDINE","20MG","60","Select","Select",""],["","00536106229","STOOL","100MG","28","Select","Select",""],["","16729018317","HYDROCHLOROT","25MG","90","Select","Select",""],["","42192032701","NP","15MG","90","Select","Select",""],["","55111064505","OMEPRAZOLE","40MG","90","Select","Select",""],["","00591352530","LIDOCAINE","5%","30","Select","Select",""],["","65162062750","TRAMADOL","50MG","14","Select","Select",""],["","61314063136","NEO\/POLY\/DEX","0.1% OP","4","Select","Select",""],["","57237001999","DULOXETINE","60MG","180","Select","Select",""],["","69238131509","PREGABALIN","200MG","180","Select","Select",""],["","27241015704","OXYBUTYNIN","15MG ER","90","Select","Select",""],["","65757030001","VIVITROL","380MG","1","Select","Select",""],["","70710122601","AMITRIPTYLIN","25MG","21","Select","Select",""],["","45802065078","LORATADINE","10MG","90","Select","Select",""],["","59267100002","PFIZER","COVID-19","0","Select","Select",""],["","00527293341","PREDNISONE","10MG","30","Select","Select",""],["","52268020101","SUTAB","","24","Select","Select",""],["","33342032915","TRIAMCINOLON","0.10%","15","Select","Select",""],["","30142030602","GENTLELAX","","238","Select","Select",""],["","29300012501","MELOXICAM","15MG","30","Select","Select",""],["","65862042001","SMZ\/TMP","800-160","6","Select","Select",""],["","58160082311","SHINGRIX","50\/0.5ML","-1","Select","Select",""],["","33342032915","TRIAMCINOLON ","CRE 0.001","15","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","",""],["Yes","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":""}]}]}