{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KAREN   P SELLS","gend":1,"add":"311 TAREYTON LN","city":"PORTSMOUTH","state":"VA","zip":"23701-9998","dob":"1971-07-22","age":"","mstatus":"","insh":"1277989*01","cliId":"","pno":"757\/619-0188","cno":"757\/619-0188","email":"","ename":"","eno":"","pphy":"SKINNER, ALISON C MD","ppno":"757\/686-5673","pcpadd":"SUITE 102 3253 TAYLOR ROAD","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":23321,"pcpcounty":"","pcpid":411053,"pcpname":"BON SECOURS WESTERN BRANCH PRIMARY CARE","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"757\/393-2550","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":["E78.5","I10.","R73.9","J20.8","R05.","J01.00","F17.210","J02.9","F17.200","Z20.828","D72.89","M25.512","Z88.5","Z00.00","Z12.11","R11.2","S46.012A","D53.9","N39.0","M79.622","T14.90XA","J40.","M79.602","E55.9","M67.814","R35.0","Z01.419","N95.1","J01.90","R63.5","Z12.31","R10.31","K76.0","U07.1","R31.9","D72.829","Z90.49","Z90.710","Z90.721","R11.0","R73.01"],"date":["2021-05-26","2021-10-24","2021-05-26","2020-04-06","2021-09-04","2020-12-29","2020-12-29","2020-12-29","2020-12-29","2021-09-04","2020-06-03","2020-11-03","2021-10-24","2021-09-21","2020-09-16","2020-09-16","2020-08-26","2021-05-26","2021-09-21","2020-08-19","2020-08-19","2021-01-14","2020-07-23","2021-09-21","2020-10-09","2021-01-27","2021-07-07","2021-07-07","2021-08-19","2021-09-21","2021-09-29","2021-10-24","2021-10-24","2021-11-19","2021-10-24","2021-10-24","2021-10-24","2021-10-24","2021-10-24","2021-10-24","2021-09-09"],"priorHcc":["",null,"","","","","","","","","","",null,"","","","","","","","","","","","","","","","","",null,null,null,null,null,null,null,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":[["","60432060416","PROMETHAZINE","DM","140","Select","Select",""],["","58657040501","ESTROG\/MTEST","1.25-2.5","-90","Select","Select",""],["","31722072250","LEVOFLOXACIN","500MG","10","Select","Select",""],["","00173068220","VENTOLIN","","18","Select","Select",""],["","51267089099","CONTRAVE","8-90MG","120","Select","Select",""],["","00093317431","ALBUTEROL","HFA","8","Select","Select",""],["","60505257909","ATORVASTATIN","20MG","90","Select","Select",""],["","15310001001","EEMT","1.25-2.5","90","Select","Select",""],["","50742061501","METOPROL","25MG ER","90","Select","Select",""],["","68180021709","LOSARTAN\/HCT","100-25","90","Select","Select",""],["","65862057490","MONTELUKAST","10MG","90","Select","Select",""],["","65862019301","FLUOXETINE","20MG","90","Select","Select",""],["","00228202950","ALPRAZOLAM","0.5MG","21","Select","Select",""],["","00591352530","LIDOCAINE","5%","30","Select","Select",""],["","67877056105","METFORMIN","500MG","90","Select","Select",""],["","00172392670","DIAZEPAM","5MG","3","Select","Select",""],["","10702025301","BUT\/APAP\/CAF","","50","Select","Select",""],["","00777310402","PROZAC","10MG","90","Select","Select",""],["","55111015330","ONDANSETRON","4MG","21","Select","Select",""],["","57237002901","AMOXICILLIN","875MG","20","Select","Select",""],["","16714069301","FLUCONAZOLE","200MG","3","Select","Select",""],["","65862062405","GEMFIBROZIL","600MG","180","Select","Select",""],["","31722071390","PANTOPRAZOLE","40MG","-90","Select","Select",""],["","63304069301","CLINDAMYCIN","300MG","30","Select","Select",""],["","59746017306","PREDNISONE","10MG","20","Select","Select",""],["","65862019105","CYCLOBENZAPR","10MG","40","Select","Select",""],["","00832003800","OXYBUTYNIN","5MG","-180","Select","Select",""],["","69238110005","DOXYCYCL","100MG","20","Select","Select",""],["","53885024510","ONETOUCH","ULTRA","100","Select","Select",""],["","16571020110","DICLOFENAC","75MG DR","30","Select","Select",""],["","67877021560","CEFUROXIME","250MG","20","Select","Select",""],["","16714065202","CIPROFLOXACN","500MG","10","Select","Select",""],["","59746000103","METHYLPRED","4MG","21","Select","Select",""],["","00173068220","VENTOLIN ","","18","Select","Select",""],["","60432060416","PROMETHAZINE ","DM","140","Select","Select",""],["","31722072250","LEVOFLOXACIN ","500MG","10","Select","Select",""],["","00093317431","ALBUTEROL ","HFA","8","Select","Select",""],["","68180021709","LOSARTAN\/HCT ","100-25","90","Select","Select",""],["","58657040501","ESTROG\/MTEST ","1.25-2.5","-90","Select","Select",""],["","15310001001","EEMT ","1.25-2.5","90","Select","Select",""],["","51267089099","CONTRAVE ","8-90MG","120","Select","Select",""],["","65862057490","MONTELUKAST ","10MG","90","Select","Select",""],["","65862019301","FLUOXETINE ","20MG","90","Select","Select",""],["","55111015330","ONDANSETRON ","4MG","21","Select","Select",""],["","50742061501","METOPROL ","25MG ER","90","Select","Select",""],["","00832003800","OXYBUTYNIN ","5MG","180","Select","Select",""],["","67877056105","METFORMIN ","500MG","90","Select","Select",""],["","60505257909","ATORVASTATIN ","20MG","90","Select","Select",""],["","69238110005","DOXYCYCL ","100MG","20","Select","Select",""],["","31722071390","PANTOPRAZOLE ","40MG","90","Select","Select",""],["","10702025301","BUT\/APAP\/CAF ","","50","Select","Select",""],["","53885000810","ONETOUCH ","PLUS 33G","100","Select","Select",""],["","59746021106","CYCLOBENZAPR ","5MG","30","Select","Select",""],["","16571020110","DICLOFENAC ","75MG DR","30","Select","Select",""],["","65862062405","GEMFIBROZIL ","600MG","180","Select","Select",""],["","00591352530","LIDOCAINE ","5%","30","Select","Select",""],["","16714069301","FLUCONAZOLE ","200MG","3","Select","Select",""],["","00228202950","ALPRAZOLAM ","0.5MG","21","Select","Select",""],["","16714065202","CIPROFLOXACN ","500MG","10","Select","Select",""],["","00172392670","DIAZEPAM ","5MG","3","Select","Select",""],["","00777310402","PROZAC ","10MG","90","Select","Select",""],["","57237002901","AMOXICILLIN ","875MG","20","Select","Select",""],["","67877021560","CEFUROXIME ","250MG","20","Select","Select",""],["","59746000103","METHYLPRED ","4MG","21","Select","Select",""],["","59746017306","PREDNISONE ","10MG","20","Select","Select",""],["","63304069301","CLINDAMYCIN ","300MG","30","Select","Select",""],["","00143924920","AMOX\/K ","875-125","20","Select","Select",""],["","65162068110","PHENAZOPYRID ","100MG","6","Select","Select",""],["","00143924920","AMOX\/K","875-125","20","Select","Select",""],["","67877057305","BENZONATATE","100MG","15","Select","Select",""],["","65162068110","PHENAZOPYRID","100MG","9","Select","Select",""],["","13107006101","PHENTERMINE","37.5MG","30","Select","Select",""],["","00781808926","AZITHROMYCIN","250MG","6","Select","Select",""],["","57664037708","TRAMADOL","50MG","18","Select","Select",""],["","13107006101","PHENTERMINE ","TAB 37.5MG","30","Select","Select",""],["","59310057922","PROAIR ","AER ","-8","Select","Select",""],["","00781808926","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","67877057305","BENZONATATE ","CAP 100MG","15","Select","Select",""],["","57664037708","TRAMADOL ","TAB 50MG","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","",""],["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":""}]}]}