{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"PEGGY   KIMBERLY  SIEBERT","gend":1,"add":"156 WEST BELVEDERE RD","city":"NORFOLK","state":"VA","zip":"23505-9998","dob":"1971-07-25","age":"","mstatus":"","insh":"1298467*02","cliId":"","pno":"757\/407-6859","cno":"757\/407-6859","email":"","ename":"","eno":"","pphy":"PHYSICIAN, PRIMARY CARE (MISC)","ppno":"","pcpadd":"4417 CORPORATION LN","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23462,"pcpcounty":"","pcpid":799999,"pcpname":"","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"407-6859","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":["G43.009","M54.12","M54.5","R31.9","G43.909","N20.0","K76.0","R10.9","Z12.31","Z12.4","Z11.51","Z01.419","H81.10","R31.29","S99.922A","E55.9","G47.9","J45.901","N92.1","R20.2","R94.6","Z00.00","N39.0","H93.293","H61.23","G43.809","R42.","Z68.32","Z13.31","Z12.39","R30.9","B00.9"],"date":["2021-01-12","2021-07-22","2020-12-15","2021-07-29","2021-07-22","2021-07-22","2020-12-15","2021-01-05","2021-07-22","2021-07-29","2021-07-29","2021-07-29","2020-01-23","2021-01-15","2021-07-07","2021-07-22","2021-07-22","2021-07-22","2021-07-22","2021-07-22","2021-07-22","2021-07-22","2021-07-22","2020-01-16","2020-01-16","2020-01-16","2020-01-16","2021-01-12","2021-01-12","2021-07-29","2021-07-29","2021-07-29"],"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":[["","31722070430","VALACYCLOVIR","500MG","90","Select","Select",""],["","70710113908","FLUCONAZOLE ","150MG","1","Select","Select",""],["","58657050016","CODEINE\/GG ","10-100\/5","120","Select","Select",""],["","67877026218","RIZATRIPTAN ","10MG","-12","Select","Select",""],["","31722070430","VALACYCLOVIR ","500MG","90","Select","Select",""],["","51672404801","CLOTRIM\/BETA ","DIPROP","15","Select","Select",""],["","69452015120","VITAMIN ","50000UNT","12","Select","Select",""],["","45802002146","BETAMETH ","0.05%","60","Select","Select",""],["","60505025103","TIZANIDINE ","2MG","-30","Select","Select",""],["","47781030301","NITROFURANTN ","100MG","14","Select","Select",""],["","68180012202","CEPHALEXIN ","500MG","14","Select","Select",""],["","60432056161","TRIAMCINOLON ","0.10%","-60","Select","Select",""],["","65162044110","MECLIZINE ","12.5MG","30","Select","Select",""],["","49281042050","FLUZONE ","2020-21","0","Select","Select",""],["","57237001401","TAMSULOSIN ","0.4MG","30","Select","Select",""],["","68462060935","PIMECROLIMUS ","1%","30","Select","Select",""],["","88888888887","DMR ","","1","Select","Select",""],["","65862050320","AMOX\/K ","875-125","20","Select","Select",""],["","70710113908","FLUCONAZOLE","150MG","1","Select","Select",""],["","58657050016","CODEINE\/GG","10-100\/5","120","Select","Select",""],["","60505025103","TIZANIDINE","2MG","30","Select","Select",""],["","65862050320","AMOX\/K","875-125","20","Select","Select",""],["","65162044110","MECLIZINE","12.5MG","30","Select","Select",""],["","51672404801","CLOTRIM\/BETA","DIPROP","15","Select","Select",""],["","69452015120","VITAMIN","50000UNT","12","Select","Select",""],["","45802002146","BETAMETH","0.05%","60","Select","Select",""],["","67877026218","RIZATRIPTAN","10MG","12","Select","Select",""],["","68180012202","CEPHALEXIN","500MG","14","Select","Select",""],["","49281042050","FLUZONE","2020-21","0","Select","Select",""],["","47781030301","NITROFURANTN","100MG","20","Select","Select",""],["","57237001401","TAMSULOSIN","0.4MG","30","Select","Select",""],["","68462060935","PIMECROLIMUS","1%","30","Select","Select",""],["","60432056161","TRIAMCINOLON","0.10%","60","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":[[["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":""}]}]}