{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LISA RUCKA","gend":1,"add":"1216 TARINGTON LNDG","city":"VIRGINIA BEACH","state":"VA","zip":"23464-9998","dob":"1965-03-04","age":"","mstatus":"","insh":"1373668*01","cliId":"","pno":"757\/288-2256","cno":"757\/288-2256","email":"","ename":"","eno":"","pphy":"BHATTACHARYYA, BISWA MD","ppno":"757\/275-9331","pcpadd":"2088 S INDEPENDENCE BLVD STE #103","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23453,"pcpcounty":"","pcpid":172075,"pcpname":"Princess Anne Family Medicine","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/416-7656","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R92.8","N63.0","R10.30","Z00.00","E55.9","R73.01","E78.2","Z12.39","I10.","R07.89","R53.83","K21.9","R10.13","K58.8","M17.12","M17.11","Z12.31","M25.561","M25.562","G89.29","M79.605","N95.0","H00.022","D06.9","L40.9","K42.9","K44.9","M47.816","Z90.49","R10.9","J20.8","B96.89","M79.662","N93.9","N30.01","Z12.11"],"date":["2020-02-04","2020-02-04","2020-05-22","2020-08-27","2021-05-25","2021-05-25","2021-05-25","2020-02-04","2021-05-25","2021-05-25","2021-05-25","2021-06-17","2021-06-17","2021-05-25","2021-04-22","2021-01-29","2021-03-19","2021-01-29","2021-04-22","2021-06-17","2021-02-18","2021-05-17","2020-08-27","2021-05-14","2021-01-29","2021-06-17","2021-06-17","2021-06-17","2021-06-17","2021-06-17","2020-03-24","2020-03-24","2021-02-18","2021-07-20","2021-07-30","2021-08-30"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",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":[["","69452015120","VITAMIN","50000UNT","12","Select","Select",""],["","65862064169","AZITHROMYCIN","250MG","-6","Select","Select",""],["","62542030117","HYD","10-8\/5ML","120","Select","Select",""],["","65862020299","LOSARTAN","50MG","180","Select","Select",""],["","61314062810","POLYMYXIN","TRIMETHP","10","Select","Select",""],["","00591544305","PREDNISONE","20MG","10","Select","Select",""],["","51672129302","CLOBETASOL","0.05%","25","Select","Select",""],["","69097052444","DICLOFENAC","1%","100","Select","Select",""],["","00555077902","MEDROXYPR","10MG","90","Select","Select",""],["","45802088830","OMEPRAZOLE","20MG","90","Select","Select",""],["","00591079501","DICYCLOMINE","20MG","-120","Select","Select",""],["","33332032001","AFLURIA","2020-21","0","Select","Select",""],["","69452015120","VITAMIN ","50000UNT","12","Select","Select",""],["","65862020299","LOSARTAN ","50MG","180","Select","Select",""],["","65862064169","AZITHROMYCIN ","250MG","-6","Select","Select",""],["","00591544305","PREDNISONE ","20MG","10","Select","Select",""],["","27808008601","HYD ","10-8\/5ML","-120","Select","Select",""],["","61314062810","POLYMYXIN ","TRIMETHP","10","Select","Select",""],["","33332032001","AFLURIA ","2020-21","0","Select","Select",""],["","68462053228","CLOBETASOL ","0.05%","-25","Select","Select",""],["","69097052444","DICLOFENAC ","1%","100","Select","Select",""],["","45802088830","OMEPRAZOLE ","20MG","90","Select","Select",""],["","00555077902","MEDROXYPR ","10MG","-60","Select","Select",""],["","00591079501","DICYCLOMINE ","20MG","120","Select","Select",""],["","00185012201","NITROFURANTN ","100MG","-14","Select","Select",""],["","00143992701","CIPROFLOXACN ","250MG","-6","Select","Select",""],["","00143992701","CIPROFLOXACN","250MG","-6","Select","Select",""],["","00185012201","NITROFURANTN","100MG","14","Select","Select",""],["","65862017760","CEFDINIR ","CAP 300MG","-14","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":""}]}]}