{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JEANETTE   M POWERS","gend":1,"add":"3101 PELHAM ST","city":"CHESAPEAKE","state":"VA","zip":"23324-9998","dob":"1962-05-01","age":"","mstatus":"","insh":"1356295*01","cliId":"","pno":"672-4741","cno":"672-4741","email":"","ename":"","eno":"","pphy":"GEORGE, LINDA J MD","ppno":"757\/962-6262","pcpadd":"STE A 1856 COLONIAL MED CT","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23454,"pcpcounty":"","pcpid":135761,"pcpname":"Trinity Medical Care PC","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"757\/227-4300","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/962-1185","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E03.9","R22.1","N30.01","M43.07","M47.27","M48.061","M51.17","M51.16","M47.26","Z12.4","E88.81","E06.3","Z68.30","Z87.891","R91.8","M54.5","M43.17","N39.0","M54.16","M43.16","M54.41","M54.42","G89.29","N95.0","Z12.31","Z85.3","Z79.891","S13.9XXA","S23.3XXA","S33.5XXA","Z88.0","Z88.5","K21.9","R11.0","N30.90","M43.06","M25.48","M51.37","R06.00","J01.00","R12.","K30.","R07.9","R14.0","I49.3","R06.02","R53.1","Z01.419","Z32.02","R92.8","Z90.12","R29.818","M47.816","M54.17","K80.50","K81.0","D05.00","N60.21","N60.82","N62.","Z86.000","L30.4","M94.0","H25.13","M51.9","T14.90XA","R20.0","I49.1","M48.07","R06.09","J06.9","S23.9XXA","V89.2XXA","Y92.9","Y93.9","M54.12","Z01.818","J45.20","R30.0","I26.99","G89.18","M47.817","M48.062","I95.81","Z98.1","Z79.890","Z80.1","Z83.3","Z82.49","Z79.899","Z01.812","Z01.810","Z51.81","R94.31","R79.9","R07.89","M54.9","I31.3","I51.7","J45.909","M51.26","Z88.6","M79.652","M54.50","M79.18","M47.819"],"date":["2021-09-09","2020-01-22","2020-02-13","2020-02-19","2021-09-09","2021-10-20","2020-02-19","2021-10-20","2021-08-27","2020-07-07","2020-12-02","2021-07-28","2020-09-16","2021-10-06","2020-07-08","2021-09-22","2021-10-06","2020-02-18","2021-10-06","2021-08-27","2021-04-01","2021-04-01","2020-07-15","2020-08-20","2021-11-16","2021-11-16","2021-09-22","2021-06-03","2021-06-03","2021-06-03","2021-10-06","2021-10-06","2021-09-09","2020-01-24","2020-02-11","2020-02-19","2020-02-19","2020-06-16","2020-07-09","2020-07-29","2021-03-19","2021-03-19","2021-09-14","2021-03-19","2020-01-21","2020-01-21","2021-04-01","2020-07-07","2020-08-19","2020-09-08","2020-09-08","2021-03-26","2021-10-20","2021-09-10","2020-01-15","2020-01-15","2020-01-15","2020-09-10","2020-09-10","2020-09-10","2020-09-10","2020-09-10","2020-09-10","2020-12-04","2021-04-07","2021-06-03","2021-03-25","2020-06-08","2021-10-20","2020-07-09","2020-02-06","2021-06-03","2021-06-03","2021-06-03","2021-06-03","2021-08-16","2021-09-07","2021-08-24","2021-08-24","2021-09-14","2021-09-14","2021-09-10","2021-09-09","2021-09-09","2021-10-20","2021-09-09","2021-09-09","2021-09-09","2021-09-09","2021-09-14","2021-08-27","2021-08-27","2021-08-27","2021-09-14","2021-08-27","2021-09-14","2021-09-14","2021-09-14","2021-09-14","2021-09-09","2021-10-20","2021-10-06","2021-10-06","2021-10-11","2021-10-06","2021-10-20"],"priorHcc":["","","","","",null,"",null,"","","","","",null,"","",null,"",null,"","","","","",null,null,"","","","",null,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":[["","68180096701","LEVOTHYROXIN","75MCG","30","Select","Select",""],["","55111015901","OMEPRAZOLE","40MG","60","Select","Select",""],["","42794001802","LIOTHYRONINE","5MCG","30","Select","Select",""],["","43386016106","MISOPROSTOL","200MCG","-2","Select","Select",""],["","67877021620","CEFUROXIME","500MG","20","Select","Select",""],["","65162027210","SMZ\/TMP","800-160","6","Select","Select",""],["","42192080201","PHENAZOPYRID","200MG","9","Select","Select",""],["","65162046450","IBUPROFEN","400MG","90","Select","Select",""],["","67877021901","CEPHALEXIN","500MG","20","Select","Select",""],["","64764017530","DEXILANT","60MG DR","-90","Select","Select",""],["","65862039010","ONDANSETRON","4MG ODT","12","Select","Select",""],["","57664037708","TRAMADOL","50MG","14","Select","Select",""],["","27241009903","DULOXETINE","60MG","30","Select","Select",""],["","69238131209","PREGABALIN","75MG","60","Select","Select",""],["","47781030301","NITROFURANTN","100MG","10","Select","Select",""],["","50228018005","GABAPENTIN","300MG","180","Select","Select",""],["","13668044201","CELECOXIB","200MG","60","Select","Select",""],["","00254101196","SUCRALFATE","1GM\/10ML","1200","Select","Select",""],["","00591352530","LIDOCAINE","5%","-30","Select","Select",""],["","63304069201","CLINDAMYCIN","150MG","30","Select","Select",""],["","72647033104","METHYLPRED","4MG","21","Select","Select",""],["","33332032001","AFLURIA","2020-21","0","Select","Select",""],["","00406324301","HYDROMORPHON","2MG","8","Select","Select",""],["","65162019010","NAPROXEN","500MG","30","Select","Select",""],["","68180096701","LEVOTHYROXIN ","75MCG","30","Select","Select",""],["","47781030301","NITROFURANTN ","100MG","10","Select","Select",""],["","67877021901","CEPHALEXIN ","500MG","20","Select","Select",""],["","55111015901","OMEPRAZOLE ","40MG","60","Select","Select",""],["","65162027210","SMZ\/TMP ","800-160","6","Select","Select",""],["","42192080201","PHENAZOPYRID ","200MG","9","Select","Select",""],["","42794001802","LIOTHYRONINE ","5MCG","30","Select","Select",""],["","50228018005","GABAPENTIN ","300MG","90","Select","Select",""],["","72647033104","METHYLPRED ","4MG","21","Select","Select",""],["","43386016106","MISOPROSTOL ","200MCG","2","Select","Select",""],["","67877021620","CEFUROXIME ","500MG","20","Select","Select",""],["","33332032001","AFLURIA ","2020-21","0","Select","Select",""],["","64764017530","DEXILANT ","60MG DR","90","Select","Select",""],["","00254101196","SUCRALFATE ","1GM\/10ML","1200","Select","Select",""],["","63304069301","CLINDAMYCIN ","300MG","28","Select","Select",""],["","65162046450","IBUPROFEN ","400MG","90","Select","Select",""],["","00406324301","HYDROMORPHON ","2MG","12","Select","Select",""],["","00591352530","LIDOCAINE ","5%","30","Select","Select",""],["","65862039010","ONDANSETRON ","4MG ODT","12","Select","Select",""],["","57664037708","TRAMADOL ","50MG","14","Select","Select",""],["","65162019010","NAPROXEN ","500MG","30","Select","Select",""],["","13668044201","CELECOXIB ","200MG","60","Select","Select",""],["","27241009903","DULOXETINE ","60MG","30","Select","Select",""],["","69238131209","PREGABALIN ","75MG","60","Select","Select",""],["","16571020110","DICLOFENAC ","75MG DR","60","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","68180096301","ALBUTEROL ","HFA","8","Select","Select",""],["","68462074635","ACYCLOVIR ","5%","30","Select","Select",""],["","68462029817","CLOTRIM\/BETA ","DIPROP","15","Select","Select",""],["","65862044930","VALACYCLOVIR ","1GM","28","Select","Select",""],["","16571020110","DICLOFENAC","75MG DR","60","Select","Select",""],["","68462074635","ACYCLOVIR","5%","30","Select","Select",""],["","68462029817","CLOTRIM\/BETA","DIPROP","15","Select","Select",""],["","59310057922","PROAIR","","-8","Select","Select",""],["","65862044930","VALACYCLOVIR","1GM","28","Select","Select",""],["","68180096301","ALBUTEROL","HFA","8","Select","Select",""],["","68382005001","MELOXICAM","7.5MG","28","Select","Select",""],["","76385012350","METHOCARBAM","500MG","40","Select","Select",""],["","00172392660","DIAZEPAM","5MG","12","Select","Select",""],["","76385012350","METHOCARBAM ","TAB 500MG","40","Select","Select",""],["","00172392660","DIAZEPAM ","TAB 5MG","12","Select","Select",""],["","68382005001","MELOXICAM ","TAB 7.5MG","28","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":""}]}]}