{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LEIGH   E RODRIGUEZ","gend":1,"add":"873 OLD CUTLER RD","city":"VIRGINIA BEACH","state":"VA","zip":"23454-9998","dob":"1969-12-14","age":"","mstatus":"","insh":"1079056*02","cliId":"","pno":"757\/412-4024","cno":"757\/412-4024","email":"","ename":"","eno":"","pphy":"THOMAS, BRANT MD","ppno":"757\/481-3770","pcpadd":"STE 4 1821 OLD DONATION PKY","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23454,"pcpcounty":"","pcpid":120796,"pcpname":"","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"757\/718-6415","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/496-4905","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M79.10","M62.838","N92.6","N95.1","R10.2","M62.9","N93.9","N83.209","N81.89","R19.04","H83.03","R00.2","R42.","Z79.890","E03.9","Z68.22","N84.0","R53.83","H69.81","R92.8","N64.89","R19.00","Z12.4","Z20.828","R68.82","H93.8X2","R51.9","H91.90","Z12.31","Z00.00","N80.3","N80.1","E03.4","D64.9","Z23.","H81.392","H93.12","G96.198","Z98.890","Z01.818","N94.89","E55.9","N81.84","N81.6","M53.2X7","H90.3","N83.201","D27.1","R79.89","H81.393","N83.202","N83.8","Z01.419","I49.1","F52.0","L03.113","H16.223","J01.90","R05.","U07.1"],"date":["2020-12-09","2020-12-09","2020-05-12","2021-10-04","2020-12-09","2020-04-15","2020-05-26","2020-06-11","2020-05-05","2020-07-06","2021-04-29","2021-05-10","2021-05-24","2021-04-29","2021-06-28","2021-04-30","2020-06-11","2021-03-19","2021-04-16","2021-02-05","2021-02-05","2020-06-19","2020-10-02","2020-12-26","2021-01-08","2021-05-24","2021-05-24","2021-05-24","2021-10-04","2020-11-13","2020-06-19","2020-06-19","2020-11-13","2020-11-13","2020-11-13","2021-04-27","2021-05-24","2021-05-24","2021-05-24","2020-06-08","2020-11-24","2020-10-23","2020-11-09","2020-11-24","2020-12-09","2021-06-25","2020-01-11","2020-06-19","2021-01-08","2021-04-19","2020-04-21","2020-04-21","2021-10-04","2021-05-04","2021-06-28","2021-07-18","2021-08-13","2021-08-28","2021-08-28","2021-08-28"],"priorHcc":["","","",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":[["","69097081312","GABAPENTIN","100MG","90","Select","Select",""],["","00046087221","PREMARIN","0.625MG","-90","Select","Select",""],["","42858010201","OXYCOD\/APAP","5-325MG","20","Select","Select",""],["","60505082901","FLUTICASONE","50MCG","48","Select","Select",""],["","69452023420","PROGESTERONE","200MG","90","Select","Select",""],["","68462015811","ONDANSETRON","8MG ODT","15","Select","Select",""],["","69238183307","LEVOTHYROXIN","88MCG","90","Select","Select",""],["","00378462226","ESTRADIOL","0.075MG","8","Select","Select",""],["","68025006630","DIVIGEL","0.5MG","30","Select","Select",""],["","00172392570","DIAZEPAM","2MG","20","Select","Select",""],["","65162046650","IBUPROFEN","800MG","30","Select","Select",""],["","65162044210","MECLIZINE","25MG","30","Select","Select",""],["","68180016013","AZITHROMYCIN","250MG","6","Select","Select",""],["","00378064205","PREDNISONE","20MG","8","Select","Select",""],["","00046087221","PREMARIN ","0.625MG","-30","Select","Select",""],["","00378180910","LEVOTHYROXIN ","100MCG","90","Select","Select",""],["","69097081312","GABAPENTIN ","100MG","90","Select","Select",""],["","42858010201","OXYCOD\/APAP ","5-325MG","20","Select","Select",""],["","68462015811","ONDANSETRON ","8MG ODT","15","Select","Select",""],["","65162046650","IBUPROFEN ","800MG","30","Select","Select",""],["","60505082901","FLUTICASONE ","50MCG","48","Select","Select",""],["","00378462226","ESTRADIOL ","0.075MG","8","Select","Select",""],["","69452023420","PROGESTERONE ","200MG","-90","Select","Select",""],["","68025006630","DIVIGEL ","0.5MG","30","Select","Select",""],["","65162044210","MECLIZINE ","25MG","30","Select","Select",""],["","68180016013","AZITHROMYCIN ","250MG","6","Select","Select",""],["","00172392570","DIAZEPAM ","2MG","20","Select","Select",""],["","00378064205","PREDNISONE ","20MG","8","Select","Select",""],["","67877021905","CEPHALEXIN ","500MG","28","Select","Select",""],["","64380071307","BENZONATATE ","200MG","30","Select","Select",""],["","50428031180","SALINE ","0.65%","44","Select","Select",""],["","59779046378","CVS ","4MG","20","Select","Select",""],["","67877057505","BENZONATATE","200MG","30","Select","Select",""],["","59779046378","CVS","4MG","100","Select","Select",""],["","50428031180","SALINE","0.65%","44","Select","Select",""],["","67877021905","CEPHALEXIN","500MG","28","Select","Select",""],["","70710113908","FLUCONAZOLE","150MG","2","Select","Select",""],["","63304069301","CLINDAMYCIN","300MG","14","Select","Select",""],["","70710113908","FLUCONAZOLE ","TAB 150MG","2","Select","Select",""],["","63304069301","CLINDAMYCIN ","CAP 300MG","14","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":""}]}]}