{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DEBORAH   J MCCUISTON","gend":1,"add":"6057 KNOTTS CREEK LN","city":"SUFFOLK","state":"VA","zip":"23435-9998","dob":"1957-08-03","age":"","mstatus":"","insh":"900045048*01","cliId":"8Y01JT2JP29","pno":"757\/371-3259","cno":"757\/371-3259","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":["J21.9","F17.200","R91.8","Z12.31","T63.441A","L03.116","J44.9","I10.","L53.9","E78.5","R73.01","R07.9"],"date":["2021-03-30","2021-03-30","2021-03-30","2021-04-08","2021-07-14","2021-07-14","2021-07-14","2021-08-25","2021-07-14","2021-08-25","2021-08-25","2021-10-07"],"priorHcc":["","","","","","","",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":[["","060505025202","TIZANIDINE ","4MG","90","Select","Select",""],["","060505258008","ATORVASTATIN ","40MG","90","Select","Select",""],["","069315011610","FUROSEMIDE ","20MG","90","Select","Select",""],["","068382014005","TOPIRAMATE ","100MG","180","Select","Select",""],["","051672126705","TRIAMCINOLON ","DEN 0.1%","5","Select","Select",""],["","062559039020","VANCOMYCIN ","125MG","60","Select","Select",""],["","068180021709","LOSARTAN\/HCT ","100-25","90","Select","Select",""],["","000406012501","HYDROCO\/APAP ","10-325MG","30","Select","Select",""],["","000832532515","POT  CL MICRO","20MEQ ER","90","Select","Select",""],["","067877021905","CEPHALEXIN ","500MG","21","Select","Select",""],["","064380080707","IBUPROFEN ","800MG","-30","Select","Select",""],["","000781223410","OMEPRAZOLE ","40MG","90","Select","Select",""],["","068462010340","FLUCONAZOLE ","150MG","1","Select","Select",""],["","000781185220","AMOX\/K ","875-125","14","Select","Select",""],["","043598081112","CETIRIZINE ","10MG","90","Select","Select",""],["","000472016615","NYSTATIN ","100000","15","Select","Select",""],["","000781261305","AMOXICILLIN ","500MG","30","Select","Select",""],["","049884005601","IMIPRAM ","50MG","90","Select","Select",""],["","000116200116","CHLORHEX ","0.12%","473","Select","Select",""],["","065862052890","VENLAFAXINE ","75MG ER","-90","Select","Select",""],["","023155050105","HYDROXYZ ","25MG","30","Select","Select",""],["","00093317431","ALBUTEROL ","HFA","51","Select","Select",""],["","00143211250","DOXYCYCL ","100MG","14","Select","Select",""],["","00121077504","GG\/CODEINE ","100-10\/5","120","Select","Select",""],["","24208063110","NEO\/POLY\/HC ","1% OTIC","10","Select","Select",""],["","68382014005","","100MG","180","Select","Select",""],["","51672126705","TRIAMCINOLON","DEN 0.1%","5","Select","Select",""],["","00781223410","OMEPRAZOLE","40MG","90","Select","Select",""],["","00832532515","POT CL MICRO","20MEQ ER","90","Select","Select",""],["","60505258008","ATORVASTATIN","40MG","90","Select","Select",""],["","69315011610","FUROSEMIDE","20MG","90","Select","Select",""],["","68180021709","LOSARTAN\/HCT","100-25","90","Select","Select",""],["","62559039020","VANCOMYCIN","125MG","60","Select","Select",""],["","68382014005","TOPIRAMATE","100MG","180","Select","Select",""],["","60505025202","TIZANIDINE","4MG","90","Select","Select",""],["","00406012501","HYDROCO\/APAP","10-325MG","30","Select","Select",""],["","64380080707","IBUPROFEN","800MG","30","Select","Select",""],["","00781185220","AMOX\/K","875-125","14","Select","Select",""],["","68462011944","FLUCONAZOLE","150MG","-1","Select","Select",""],["","67877021905","CEPHALEXIN","500MG","21","Select","Select",""],["","43598081115","CETIRIZINE","10MG","90","Select","Select",""],["","69315013501","IMIPRAM","50MG","-90","Select","Select",""],["","65862052890","VENLAFAXINE","75MG ER","-90","Select","Select",""],["","23155050105","HYDROXYZ","25MG","30","Select","Select",""],["","00781261305","AMOXICILLIN","500MG","30","Select","Select",""],["","00093317431","ALBUTEROL","HFA","51","Select","Select",""],["","00527293441","PREDNISONE","20MG","18","Select","Select",""],["","00121077504","GG\/CODEINE","100-10\/5","120","Select","Select",""],["","27808006502","PROMETH\/COD","6.25-10","120","Select","Select",""],["","42806071401","BENZONATATE","100MG","90","Select","Select",""],["","00472016615","NYSTATIN","100000","15","Select","Select",""],["","00116200116","CHLORHEX","0.12%","473","Select","Select",""],["","24208063110","NEO\/POLY\/HC","1% OTIC","10","Select","Select",""],["","00143211250","DOXYCYCL","100MG","14","Select","Select",""],["","49281072110","FLUBLOK","2021-22","0","Select","Select",""],["","58160082311","SHINGRIX","50\/0.5ML","1","Select","Select",""],["","27808006502","PROMETH\/COD ","SOL 6.25-10","120","Select","Select",""],["","49281072110","FLUBLOK ","INJ 2021-22","0","Select","Select",""],["","58160082311","SHINGRIX ","INJ 50\/0.5ML","1","Select","Select",""],["","42806071401","BENZONATATE ","CAP 100MG","90","Select","Select",""],["","00527293441","PREDNISONE ","TAB 20MG","18","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":""}]}]}