{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"EMILY MORAD","gend":1,"add":"2045 IOWA ST","city":"CHESAPEAKE","state":"VA","zip":"23323-9998","dob":"1979-05-16","age":"","mstatus":"","insh":"1119386*01","cliId":"","pno":"757\/277-1698","cno":"757\/277-1698","email":"","ename":"","eno":"","pphy":"FEE, ERIC MD","ppno":"757\/587-0157","pcpadd":"7924 CHESAPEAKE BLVD","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23518,"pcpcounty":"","pcpid":670139,"pcpname":"Bayview Medical Center","plan":"OHP","program":"ACA","lob":"Individual","region":"TIDEWATER","aligned":"","ano":"757\/480-3800","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":["K76.0","R00.2","M54.5","G89.29","R53.1","Z90.49","E66.01","Z86.73","E78.00","K21.9","G89.4","R10.11","M51.44","M51.14","S90.32XA","R00.0","I49.3","R00.8","R42.","R60.0","M25.531","Z79.891","M16.0","M47.816","G47.33","D50.8","Z01.818","M75.42","R35.0","R11.0","R10.84","K50.90","K92.1","R29.898","G43.109","K22.8","K44.9","K92.0","Z30.430","L82.1","D22.9","D18.01","Z12.39","R32.","Z13.31","S40.011A","R51.9","R30.9","R07.9","R06.02","R19.7","K29.51","K51.90","R20.0","R20.2","G56.00","Z00.00","E78.5","E78.01","E04.2","Z98.890","E66.9","R06.83","M51.45","I10.","E89.0","I69.351","Z79.3","Z79.899","Z88.0","Z88.1","Z88.5","K92.2","G47.10","G56.01","M54.12","N76.0","N76.2","N85.2","N92.5","R10.31","N85.00","Z97.5","M79.672","S99.922A","M19.072","Z20.828","I45.81","R55.","R94.31","R25.1","M25.539","R52.","R09.81","J30.1","Z01.812","Z20.822","R41.0","D50.9","R63.4","G47.9","Z23.","R51.","Z82.3","M54.6","L81.8","M25.552","N89.8","Z30.431","M25.512","M79.631","M79.641","M25.562","M54.2","M47.26","M47.27","M48.061","M51.46","M96.0","N94.10","M75.22","R07.89","R10.13","K64.8","K64.4","Z68.41","R41.840","R39.15","E78.2","Z68.42","G47.30","Z87.19","G47.00","Z12.4","Z12.31","R10.2","S69.91XA","M85.68","M67.431","H90.41","E55.9","M75.100","S09.90XA","E86.0","M54.41","M54.42","S60.211A","D64.9","R73.9","Z68.37","R53.83","Z01.411","N72.","Z88.8","M99.05","Z30.40","K50.911","Z82.49","I63.9","K31.89","Z85.3","Z87.440","Z80.3","J34.89","J34.2","J34.3","J30.9","F48.8","K50.919","Z83.49","M25.812","M48.02","K29.70","Z68.36","Z88.6","Z88.3","R11.2","M79.18","R05.","K62.5","R10.9"],"date":["2021-07-01","2021-03-26","2021-04-02","2020-09-21","2021-05-07","2021-07-01","2021-06-23","2021-07-01","2021-04-29","2021-06-22","2021-04-22","2021-07-01","2021-01-19","2021-04-22","2020-12-22","2021-04-12","2021-01-14","2021-01-14","2021-03-24","2021-02-03","2021-02-03","2021-04-22","2021-02-19","2021-04-22","2021-04-05","2021-06-07","2021-06-05","2021-06-09","2021-03-05","2021-05-07","2020-01-27","2021-07-01","2021-04-26","2020-04-22","2020-03-21","2020-06-22","2021-07-01","2020-06-22","2020-06-29","2020-10-20","2020-10-20","2020-10-20","2020-11-14","2021-03-24","2021-05-19","2021-01-07","2021-03-02","2021-03-05","2021-04-02","2021-06-10","2021-04-22","2021-04-29","2021-06-09","2020-04-01","2020-04-01","2021-04-10","2021-03-24","2021-07-01","2020-04-01","2020-02-07","2021-04-26","2021-03-11","2020-07-01","2020-04-22","2021-06-23","2020-06-22","2021-06-23","2021-04-14","2021-07-01","2021-07-01","2021-07-01","2021-07-01","2020-06-01","2020-07-01","2021-04-14","2020-07-14","2020-09-15","2020-09-15","2020-10-15","2020-09-29","2020-10-15","2020-10-15","2021-04-26","2020-11-09","2020-11-09","2020-11-09","2020-12-19","2020-12-27","2021-03-24","2021-03-24","2020-12-31","2021-01-20","2021-05-12","2021-03-31","2021-03-31","2021-04-23","2021-04-23","2021-05-07","2021-06-08","2021-04-30","2021-06-22","2020-02-07","2020-03-20","2021-04-26","2020-04-22","2020-06-02","2020-09-15","2020-09-29","2020-09-29","2021-06-10","2020-12-27","2020-12-27","2020-12-27","2020-12-27","2021-01-02","2021-01-02","2021-01-02","2021-01-02","2021-01-02","2021-01-15","2021-06-09","2021-06-10","2021-06-23","2021-04-12","2021-04-12","2021-04-26","2021-05-07","2020-01-27","2020-03-20","2020-06-22","2020-04-28","2020-04-28","2020-04-28","2020-06-09","2020-11-14","2021-03-05","2021-02-03","2021-02-03","2021-02-03","2021-02-10","2021-05-19","2021-05-19","2020-12-28","2020-12-28","2021-01-02","2021-01-02","2021-01-06","2021-05-07","2021-05-07","2021-06-10","2021-05-07","2020-06-09","2020-06-09","2020-06-22","2021-02-11","2021-02-11","2021-04-02","2021-04-14","2020-03-20","2020-06-22","2020-12-28","2021-07-01","2020-12-28","2021-01-27","2021-01-27","2021-01-27","2021-01-27","2021-03-24","2021-04-13","2021-04-26","2021-06-09","2021-06-09","2021-06-23","2021-06-23","2021-06-23","2021-06-23","2021-06-23","2021-03-05","2021-06-10","2021-07-01","2021-07-01"],"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":[["","00378161005","DICYCLOMINE","10MG","180","Select","Select",""],["","42494030124","HYDROCORT","25MG","28","Select","Select",""],["","42858010301","OXYCOD\/APAP","7.5-325","12","Select","Select",""],["","65862018730","ONDANSETRON","4MG","30","Select","Select",""],["","60505258008","ATORVASTATIN","40MG","90","Select","Select",""],["","59746017710","CYCLOBENZAPR","10MG","60","Select","Select",""],["","62175011843","OMEPRAZOLE","20MG","60","Select","Select",""],["","33342010215","MONTELUKAST","10MG","30","Select","Select",""],["","00603459315","METHYLPRED","4MG","21","Select","Select",""],["","00904675180","ASPIRIN","81MG EC","30","Select","Select",""],["","69547035302","NARCAN","","2","Select","Select",""],["","69452015120","VITAMIN","50000UNT","8","Select","Select",""],["","68462010340","FLUCONAZOLE","150MG","2","Select","Select",""],["","70010077001","METHOCARBAM","750MG","12","Select","Select",""],["","45802086866","POLYETH","3350 NF","-15","Select","Select",""],["","57237001930","DULOXETINE","60MG","90","Select","Select",""],["","00406831501","MORPHINE","15MG ER","60","Select","Select",""],["","00093314705","CEPHALEXIN","500MG","12","Select","Select",""],["","69097052444","DICLOFENAC","1%","100","Select","Select",""],["","10702000350","PROMETHAZINE","25MG","120","Select","Select",""],["","51672130200","TERCONAZOLE","0.80%","20","Select","Select",""],["","69315090410","LORAZEPAM","0.5MG","2","Select","Select",""],["","10702005601","OXYCODONE","10MG","18","Select","Select",""],["","59267100001","PFIZER","COVID-19","0","Select","Select",""],["","00378161005","DICYCLOMINE ","10MG","-180","Select","Select",""],["","62175089143","ATORVASTATIN ","20MG","30","Select","Select",""],["","33342010215","MONTELUKAST ","10MG","30","Select","Select",""],["","62175011843","OMEPRAZOLE ","20MG","60","Select","Select",""],["","65862018730","ONDANSETRON ","4MG","30","Select","Select",""],["","00904675180","ASPIRIN ","81MG EC","90","Select","Select",""],["","42494030124","HYDROCORT ","25MG","-28","Select","Select",""],["","42858010301","OXYCOD\/APAP ","7.5-325","12","Select","Select",""],["","69097052444","DICLOFENAC ","1%","100","Select","Select",""],["","59746017710","CYCLOBENZAPR ","10MG","60","Select","Select",""],["","69547035302","NARCAN ","","2","Select","Select",""],["","70010077001","METHOCARBAM ","750MG","12","Select","Select",""],["","68462010340","FLUCONAZOLE ","150MG","2","Select","Select",""],["","00832027311","MORPHINE ","15MG","60","Select","Select",""],["","69315090410","LORAZEPAM ","0.5MG","2","Select","Select",""],["","00093314705","CEPHALEXIN ","500MG","12","Select","Select",""],["","10702005601","OXYCODONE ","10MG","18","Select","Select",""],["","10702000350","PROMETHAZINE ","25MG","120","Select","Select",""],["","69452015120","VITAMIN ","50000UNT","12","Select","Select",""],["","51672130200","TERCONAZOLE ","0.80%","20","Select","Select",""],["","57237001930","DULOXETINE ","60MG","90","Select","Select",""],["","45802086866","POLYETH ","3350 NF","14","Select","Select",""],["","00603459315","METHYLPRED ","4MG","21","Select","Select",""],["","59267100001","PFIZER ","COVID-19","0","Select","Select",""],["","88888888887","DMR ","","1","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":[[["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["No","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":""}]}]}