{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KATHLEEN   K DUVAL","gend":1,"add":"3408 E OCEANVIEW AVE APT 9","city":"NORFOLK","state":"VA","zip":"23518-9998","dob":"1970-05-08","age":"","mstatus":"","insh":"1026926*02","cliId":"","pno":"757\/355-7492","cno":"757\/355-7492","email":"","ename":"","eno":"","pphy":"FRANK, JANINE M MD","ppno":"757\/689-8430","pcpadd":"1925 GLENN MITCHELL DR STE 101","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23456,"pcpcounty":"","pcpid":141974,"pcpname":"Pembroke Medical Associates","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"757\/355-4586","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/689-8435","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M54.5","M25.551","R55.","G50.0","M26.609","R25.2","Z12.31","R92.2","Z80.3","Z12.39","N64.4","S16.1XXA","M62.838","I89.0","R20.2","Z20.828","G44.011","E04.1","Q82.0","M79.661","M79.662","I87.393","R60.0","R10.11","R16.0","E78.1","Z12.11","G44.001","R20.0","M26.69","R68.84","Q28.3","J30.9","I10.","F41.8","G44.029","G56.01","M62.89","E66.9","Z68.41","Z88.1","Z88.8","Z88.0","Z88.5","R51.9","L91.8","D22.5","L57.8","M26.633","Z23.","E66.01","M50.21","M50.222","M47.812","M50.221","R25.1","M47.816","M48.02","Q76.49","M54.2","S03.40XD","M54.16","M54.12","R29.898"],"date":["2021-07-09","2021-07-09","2021-03-26","2021-06-30","2021-06-30","2021-06-30","2021-06-23","2021-06-23","2021-06-23","2021-06-23","2021-06-23","2020-04-24","2020-04-24","2021-08-27","2021-06-27","2020-11-14","2021-01-14","2021-01-14","2021-03-04","2021-03-04","2021-03-04","2021-03-04","2021-03-04","2020-04-13","2020-04-13","2020-04-13","2020-04-13","2021-01-14","2021-01-14","2021-01-14","2021-01-14","2021-01-14","2021-05-28","2021-05-28","2021-06-28","2021-01-27","2021-06-23","2021-03-26","2021-03-26","2021-06-28","2021-03-26","2021-03-26","2021-03-26","2021-03-26","2021-03-26","2021-04-14","2021-04-14","2021-04-14","2021-11-12","2021-05-27","2021-06-28","2021-06-27","2021-06-27","2021-06-27","2021-06-27","2021-06-27","2021-06-27","2021-06-27","2021-06-27","2021-06-27","2021-06-17","2021-09-08","2021-10-07","2021-08-27"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",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":[["","31722053401","METHOCARBAM","750MG","180","Select","Select",""],["","00116200116","CHLORHEX","0.12%","473","Select","Select",""],["","00115174801","METAXALONE","800MG","-90","Select","Select",""],["","43598081115","CETIRIZINE","10MG","90","Select","Select",""],["","13668013610","ESCITALOPRAM","10MG","60","Select","Select",""],["","80777027399","MODERNA","COVID-19","0","Select","Select",""],["","62756018488","OXCARBAZEPIN","300MG","-60","Select","Select",""],["","69315011610","FUROSEMIDE","20MG","30","Select","Select",""],["","68180047802","SIMVASTATIN","10MG","90","Select","Select",""],["","68462017901","NAPROXEN","550MG","30","Select","Select",""],["","31722053401","METHOCARBAM ","750MG","-180","Select","Select",""],["","00116200116","CHLORHEX ","0.12%","473","Select","Select",""],["","00115174801","METAXALONE ","800MG","90","Select","Select",""],["","68180047802","SIMVASTATIN ","10MG","90","Select","Select",""],["","80777027399","MODERNA ","COVID-19","0","Select","Select",""],["","62756018488","OXCARBAZEPIN ","300MG","-60","Select","Select",""],["","69315011610","FUROSEMIDE ","20MG","30","Select","Select",""],["","68462017901","NAPROXEN ","550MG","30","Select","Select",""],["","43598081115","CETIRIZINE ","10MG","90","Select","Select",""],["","13668013610","ESCITALOPRAM ","10MG","60","Select","Select",""],["","00406012401","HYDROCO\/APAP ","TAB 7.5-325","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","",""],["N\/A","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","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":""}]}]}