{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JEFFREY   Q NEWKIRK","gend":0,"add":"1390 E TANNERS CREEK ROAD","city":"NORFOLK","state":"VA","zip":"23513-9998","dob":"1966-09-20","age":"","mstatus":"","insh":"1158343*01","cliId":"","pno":"757\/362-4262","cno":"757\/362-4262","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":"Small Group","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/587-0074","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J06.9","R05.","R10.9","J18.9","Z20.822","F17.210","Z20.828","Z71.89","Z90.49","M54.5","E66.09","Z68.37","M54.9","J30.1","E66.9","Z79.899","Z87.09","R09.89","S22.22XA","S22.43XA","N28.1","K44.9","K42.9","M17.0","M47.9","M50.30","J45.909","S50.912A","Z72.0","Z23.","S22.20XA","S63.502A","S22.49XA","V87.7XXA","M54.41","R91.8","L29.9","R21.","Z68.39","M54.16","M79.604","M54.31","M54.40","Z12.11","S06.350A","S01.311A","R40.2410","S29.9XXA","S39.91XA","R51.9","S06.9X9A","I61.9","S09.90XA","S19.9XXA","M17.11","S80.00XA","S01.319A","Z48.02"],"date":["2020-08-11","2020-08-11","2020-08-15","2020-08-24","2021-02-24","2021-09-02","2021-02-09","2020-08-15","2020-08-15","2020-12-16","2021-10-13","2021-04-07","2020-12-16","2021-04-07","2021-05-06","2021-07-20","2021-04-07","2021-04-07","2020-01-03","2020-01-03","2020-01-03","2020-01-03","2020-01-03","2020-01-03","2020-01-03","2020-01-03","2020-06-09","2020-01-03","2021-09-02","2020-01-03","2020-01-23","2020-01-04","2020-01-23","2021-10-27","2020-06-09","2020-08-15","2021-05-06","2021-05-06","2021-10-13","2021-10-06","2021-09-02","2021-09-02","2021-10-06","2021-08-30","2021-10-13","2021-10-13","2021-10-13","2021-10-13","2021-10-13","2021-10-13","2021-10-13","2021-10-13","2021-10-13","2021-10-13","2021-10-13","2021-10-27","2021-10-27","2021-10-27"],"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":[["","66993001968","ALBUTEROL","HFA","18","Select","Select",""],["","65862018501","CLINDAMYCIN","150MG","28","Select","Select",""],["","00378064205","PREDNISONE","20MG","15","Select","Select",""],["","00603188016","LIDOCAINE","5%","-30","Select","Select",""],["","00173068220","VENTOLIN","","18","Select","Select",""],["","45802091987","CETIRIZINE","10MG","14","Select","Select",""],["","00054327099","FLUTICASONE","50MCG","16","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","58657050016","CODEINE\/GG","10-100\/5","120","Select","Select",""],["","59267100002","PFIZER","COVID-19","0","Select","Select",""],["","64380080707","IBUPROFEN","800MG","30","Select","Select",""],["","00406012305","HYDROCO\/APAP","5-325MG","8","Select","Select",""],["","71093014005","METHOCARBAM","500MG","16","Select","Select",""],["","68180016013","AZITHROMYCIN","250MG","6","Select","Select",""],["","59779048462","PAIN","500MG","20","Select","Select",""],["","16714008210","HYDROXYZ","25MG","30","Select","Select",""],["","00378064205","PREDNISONE ","20MG","15","Select","Select",""],["","64380080707","IBUPROFEN ","800MG","30","Select","Select",""],["","65862018501","CLINDAMYCIN ","150MG","28","Select","Select",""],["","71093014005","METHOCARBAM ","500MG","16","Select","Select",""],["","00406012305","HYDROCO\/APAP ","5-325MG","8","Select","Select",""],["","66993001968","ALBUTEROL ","HFA","18","Select","Select",""],["","58657050016","CODEINE\/GG ","10-100\/5","120","Select","Select",""],["","00173068220","VENTOLIN ","","18","Select","Select",""],["","68180016013","AZITHROMYCIN ","250MG","6","Select","Select",""],["","59779048462","PAIN ","500MG","20","Select","Select",""],["","00603188016","LIDOCAINE ","5%","30","Select","Select",""],["","00054327099","FLUTICASONE ","50MCG","16","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","45802091987","CETIRIZINE ","10MG","14","Select","Select",""],["","59267100002","PFIZER ","COVID-19","0","Select","Select",""],["","16714008210","HYDROXYZ ","25MG","30","Select","Select",""],["","00591565810","CYCLOBENZAPR ","10MG","15","Select","Select",""],["","00591565810","CYCLOBENZAPR","10MG","15","Select","Select",""],["","00172392670","DIAZEPAM","5MG","20","Select","Select",""],["","70461032103","FLUCLVX","2021-22","0","Select","Select",""],["","00172392670","DIAZEPAM ","TAB 5MG","20","Select","Select",""],["","70461032103","FLUCLVX ","INJ 2021-22","0","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":""}]}]}