{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SANDRA JARED","gend":1,"add":"2305 BEACH HAVEN DR APT 203","city":"VIRGINIA BEACH","state":"VA","zip":"23451-9998","dob":"1965-10-22","age":"","mstatus":"","insh":"1415900*01","cliId":"","pno":"757\/403-4518","cno":"757\/403-4518","email":"","ename":"","eno":"","pphy":"PAULSEN, MICHELLE DO","ppno":"757\/495-0606","pcpadd":"SUITE 103 516 INNOVATION DRIVE","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":23320,"pcpcounty":"","pcpid":131473,"pcpname":"","plan":"OHP","program":"ACA","lob":"Individual","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/842-6605","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J06.9","J20.9","J01.90","H92.09","D51.9","Z71.3","M43.16","M54.5","Z01.818","M51.16","M48.061","M51.17","M46.96","M25.511","E53.8","Z79.891","Z20.828","N20.0","F33.2","M54.6","M54.16","Z12.31","I10.","F41.9","D64.9","Z66.","Z87.891","M79.7","Z79.899","Z51.81","Z01.419","N95.1","M35.9","E55.9","F90.0","F41.1","G47.00","D50.0","R10.2","N39.46","R39.14","R35.0","K59.00","M47.816","F43.21","M53.2X6","M25.512","D48.5","L57.0","D22.5","L81.4","L82.1","M47.812","M47.817","M51.36","M47.26","Z98.890","Z12.11","Z23.","Z00.00","D72.819","R07.9","H40.013","Z98.1","L81.8","K76.0","Z90.49","I73.00","M85.859","M75.52","N30.01","N20.1","N20.2","Z88.6","Z88.8","R10.9","R82.992","M47.896","N32.81","N39.41","K59.04","R14.0","R19.7","R00.2","M54.40","G89.29","R94.111","F51.01","Z98.0","F51.05","R53.82","J30.0","K90.49","T78.1XXA","D75.89","Z01.810","M77.02","L98.9","N32.89","L20.81","M42.16","G12.9","M25.412","R52.","M18.11","M19.049","R63.5","D69.2","D50.9","M18.0","N76.0","Z11.3","K21.9","J37.0","R49.0","L30.9","R63.6"],"date":["2020-01-07","2020-01-07","2020-01-07","2020-01-07","2021-10-07","2021-11-04","2021-10-18","2021-07-12","2020-10-14","2020-10-27","2020-05-12","2020-05-12","2020-05-12","2021-02-02","2020-05-19","2021-06-15","2021-01-22","2021-11-09","2021-11-03","2021-03-09","2021-06-07","2020-10-21","2021-11-09","2021-10-07","2021-10-07","2020-10-27","2020-10-27","2021-10-07","2020-12-29","2021-07-27","2020-12-14","2020-12-14","2021-09-28","2021-10-07","2021-06-01","2021-06-01","2021-09-27","2021-08-12","2021-08-06","2021-08-06","2021-08-06","2021-08-06","2021-08-06","2021-07-12","2021-10-04","2020-04-07","2020-06-09","2021-01-07","2021-01-07","2020-09-11","2020-09-11","2020-09-11","2020-09-30","2020-01-30","2021-02-01","2020-05-12","2020-05-12","2021-09-02","2021-10-07","2021-07-01","2021-08-05","2020-09-02","2020-09-18","2021-10-18","2021-01-07","2021-03-01","2021-03-01","2021-09-28","2021-09-28","2020-06-09","2020-08-10","2020-08-10","2020-08-10","2020-08-10","2020-08-10","2021-09-02","2021-11-09","2020-08-25","2021-01-28","2021-01-28","2021-08-04","2021-08-04","2021-10-29","2021-10-28","2020-10-27","2020-10-27","2020-02-05","2021-03-18","2020-05-12","2020-07-14","2020-11-30","2021-03-16","2021-03-16","2021-03-16","2020-04-09","2020-10-14","2021-10-14","2020-03-02","2020-08-10","2020-03-20","2020-03-31","2020-03-31","2020-06-08","2021-07-01","2021-07-01","2021-07-01","2021-09-02","2021-09-03","2021-09-02","2021-10-14","2021-11-08","2021-11-08","2021-10-29","2021-10-12","2021-10-29","2021-11-10","2021-11-09"],"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":[["","27241009903","DULOXETINE","60MG","84","Select","Select",""],["","47335050696","CEQUA","0.09%","60","Select","Select",""],["","00143962125","CYANOCOBALAM","1000MCG","2","Select","Select",""],["","50742061501","METOPROL","25MG ER","30","Select","Select",""],["","00832030000","CHLORPROMAZ","10MG","-150","Select","Select",""],["","59417010410","VYVANSE","40MG","30","Select","Select",""],["","00093101042","MUPIROCIN","2%","22","Select","Select",""],["","00456120230","LINZESS","290MCG","30","Select","Select",""],["","65862050320","AMOX\/K","875-125","20","Select","Select",""],["","67877057305","BENZONATATE","100MG","40","Select","Select",""],["","13107004405","OXYCOD\/APAP","5-325MG","30","Select","Select",""],["","67877014701","TEMAZEPAM","30MG","30","Select","Select",""],["","00378400505","ALPRAZOLAM","1MG","-90","Select","Select",""],["","00378443001","FLURAZEPAM","30MG","-30","Select","Select",""],["","68968345008","ESTRADIOL","0.05MG","8","Select","Select",""],["","00781620693","BIMATOPROST","0.03%","3","Select","Select",""],["","68382005101","MELOXICAM","15MG","14","Select","Select",""],["","00378905593","LIDOCAINE","5%","30","Select","Select",""],["","00023916360","RESTASIS","0.05%","180","Select","Select",""],["","65162062710","TRAMADOL","50MG","56","Select","Select",""],["","70010075401","METHOCARBAM","500MG","40","Select","Select",""],["","43598065530","BUPROPN","150MG XL","90","Select","Select",""],["","43386002860","CLOBETASOL","0.05%","50","Select","Select",""],["","00406324301","HYDROMORPHON","2MG","-42","Select","Select",""],["","16714072902","DESONIDE","0.05%","60","Select","Select",""],["","13668044201","CELECOXIB","200MG","30","Select","Select",""],["","60505082601","IPRATROPIUM","0.03%","30","Select","Select",""],["","31722082030","ARIPIPRAZOLE","5MG","-30","Select","Select",""],["","11822517540","RA","100MG","30","Select","Select",""],["","00832532511","POT CL MICRO","20MEQ ER","90","Select","Select",""],["","67877021901","CEPHALEXIN","500MG","14","Select","Select",""],["","65862039010","ONDANSETRON","4MG ODT","12","Select","Select",""],["","65862059801","TAMSULOSIN","0.4MG","90","Select","Select",""],["","68382053701","POT CITRATE","1080MG","90","Select","Select",""],["","11822041250","ACETAMIN","500MG","60","Select","Select",""],["","54838051240","DOXEPIN","10MG\/ML","30","Select","Select",""],["","88888888887","DMR","","1","Select","Select",""],["","65862050320","AMOX\/K ","875-125","20","Select","Select",""],["","67877057305","BENZONATATE ","100MG","40","Select","Select",""],["","27241009903","DULOXETINE ","60MG","60","Select","Select",""],["","47335050696","CEQUA ","0.09%","60","Select","Select",""],["","00143962125","CYANOCOBALAM ","1000MCG","2","Select","Select",""],["","59417010410","VYVANSE ","40MG","30","Select","Select",""],["","50742061501","METOPROL ","25MG ER","30","Select","Select",""],["","00832030000","CHLORPROMAZ ","10MG","-150","Select","Select",""],["","68968345008","ESTRADIOL ","0.05MG","8","Select","Select",""],["","00456120230","LINZESS ","290MCG","30","Select","Select",""],["","00378400505","ALPRAZOLAM ","1MG","60","Select","Select",""],["","00093101042","MUPIROCIN ","2%","22","Select","Select",""],["","67877014701","TEMAZEPAM ","30MG","30","Select","Select",""],["","13107004405","OXYCOD\/APAP ","5-325MG","30","Select","Select",""],["","68382005001","MELOXICAM ","7.5MG","7","Select","Select",""],["","00781620675","BIMATOPROST ","0.03%","5","Select","Select",""],["","00378905593","LIDOCAINE ","5%","-30","Select","Select",""],["","88888888887","DMR ","","1","Select","Select",""],["","00023916360","RESTASIS ","0.05%","180","Select","Select",""],["","43386002860","CLOBETASOL ","0.05%","50","Select","Select",""],["","00832532511","POT  CL MICRO","20MEQ ER","-90","Select","Select",""],["","00378443001","FLURAZEPAM ","30MG","-30","Select","Select",""],["","65862039010","ONDANSETRON ","4MG ODT","12","Select","Select",""],["","67877021901","CEPHALEXIN ","500MG","14","Select","Select",""],["","65862059801","TAMSULOSIN ","0.4MG","14","Select","Select",""],["","68180031906","BUPROPN ","150MG XL","30","Select","Select",""],["","65162062710","TRAMADOL ","50MG","56","Select","Select",""],["","68382053701","POT  CITRATE ","1080MG","90","Select","Select",""],["","11822041250","ACETAMIN ","500MG","60","Select","Select",""],["","00406324301","HYDROMORPHON ","2MG","42","Select","Select",""],["","16714072902","DESONIDE ","0.05%","60","Select","Select",""],["","70010075401","METHOCARBAM ","500MG","-40","Select","Select",""],["","11822517540","RA ","100MG","30","Select","Select",""],["","13668044201","CELECOXIB ","200MG","30","Select","Select",""],["","54838051240","DOXEPIN ","10MG\/ML","-30","Select","Select",""],["","31722081930","ARIPIPRAZOLE ","2MG","30","Select","Select",""],["","60505082601","IPRATROPIUM ","0.03%","30","Select","Select",""],["","67877019805","AMLODIPINE","5MG","-30","Select","Select",""],["","62856041030","DAYVIGO","10MG","30","Select","Select",""],["","45802013970","METRONIDAZOL","0.75%VAG","70","Select","Select",""],["","65862086001","FAMOTIDINE","40MG","30","Select","Select",""],["","67877019805","AMLODIPINE ","TAB 5MG","-30","Select","Select",""],["","65862086001","FAMOTIDINE ","TAB 40MG","30","Select","Select",""],["","70700026894","FOSFOMYCIN ","POW 3GM","3","Select","Select",""],["","62856041030","DAYVIGO ","TAB 10MG","30","Select","Select",""],["","45802013970","METRONIDAZOL ","GEL 0.75%VAG","70","Select","Select",""],["","65162047810","NITROFURANTN ","CAP 100MG","-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":""}]}]}