{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ELLA COOPER","gend":1,"add":"2920 AUGUSTA CIR","city":"VIRGINIA BEACH","state":"VA","zip":"23453-9998","dob":"1961-05-01","age":"","mstatus":"","insh":"1471058*01","cliId":"","pno":"757\/468-1475","cno":"757\/468-1475","email":"","ename":"","eno":"","pphy":"BOULANGER, PHILIP MD","ppno":"757\/222-0300","pcpadd":"2901 SOUTH LYNNHAVEN ROAD SUITE 450","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23452,"pcpcounty":"","pcpid":190887,"pcpname":"","plan":"OHP","program":"ACA","lob":"Individual","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/213-9573","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R41.0","R41.3","Q28.3","L93.2","M32.9","I10.","J45.30","F33.9","Z68.29","G43.109","M54.2","E55.9","M50.30","M47.812","M46.90","J18.9","J45.31","R19.5","U07.1","D48.5","Z71.9","Z12.11","Z12.31","R51.9","E78.5","J45.909","L93.0","G89.29","J30.9","R73.9","I11.9","M06.9","M79.7","Z82.49","Z87.891","Z88.8","Z88.2","Z91.018","R42.","R00.2","M54.12","F41.9","M25.50","L93.1","R10.84","K57.30","R07.9","J98.4","J12.82","E66.9","Z68.30","Z86.11","Z90.49","Z80.8","K21.9","J45.20","R06.83","Z00.01","Z23.","I49.1","I49.3","Z79.899","F32.9","R53.1","I08.1","R00.8","N39.0","M54.5","M25.551","M25.552","M47.816","M16.0","M50.10","M46.93","M99.71","M46.1","R01.1","G43.009","M50.123","M47.23","M70.61","M70.62","G44.89","M72.2","M79.671","M24.571","M24.572"],"date":["2020-03-18","2020-03-18","2020-03-18","2021-05-11","2021-04-22","2021-11-08","2020-11-12","2020-09-17","2020-12-09","2020-04-02","2020-09-17","2020-09-17","2020-12-09","2020-12-09","2020-12-09","2021-02-01","2021-02-01","2021-02-01","2021-04-12","2021-05-11","2021-05-11","2020-02-17","2021-02-25","2020-12-09","2021-09-15","2021-03-15","2021-09-15","2020-06-17","2020-01-09","2020-10-08","2020-10-08","2021-01-07","2021-09-15","2021-01-07","2021-01-07","2021-01-07","2021-01-07","2021-01-07","2020-11-03","2021-07-27","2020-11-12","2020-11-12","2021-08-16","2021-08-16","2021-01-07","2021-01-07","2021-01-07","2021-01-07","2021-04-12","2021-11-08","2021-01-07","2021-01-07","2021-01-07","2021-01-07","2021-04-12","2021-01-26","2021-01-26","2021-03-15","2021-03-15","2021-03-16","2021-03-16","2021-04-22","2021-04-12","2020-10-08","2020-11-03","2020-11-03","2021-04-23","2021-08-16","2021-05-18","2021-05-18","2021-05-18","2021-05-18","2020-11-03","2020-11-03","2020-11-03","2021-04-23","2021-09-01","2020-06-11","2020-11-03","2020-11-03","2021-08-16","2021-08-16","2021-09-15","2021-11-22","2021-11-22","2021-11-22","2021-11-22"],"priorHcc":["","","","","",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":[["","68382080601","TRAZODONE","100MG","30","Select","Select",""],["","69097084507","CYCLOBENZAPR","5MG","30","Select","Select",""],["","64380073706","VITAMIN","50000UNT","4","Select","Select",""],["","68382009605","HYDROXYCHLOR","200MG","30","Select","Select",""],["","00591288601","VERAPAMIL","360MG SR","30","Select","Select",""],["","00186091612","PULMICORT","180MCG","1","Select","Select",""],["","00172572970","FAMOTIDINE","40MG","30","Select","Select",""],["","69097012203","TOPIRAMATE","25MG","100","Select","Select",""],["","62332014231","CELECOXIB","200MG","30","Select","Select",""],["","00591352530","LIDOCAINE","5%","10","Select","Select",""],["","68382004001","PROMETHAZINE","12.5MG","16","Select","Select",""],["","59746000103","METHYLPRED","4MG","21","Select","Select",""],["","00093317431","ALBUTEROL","HFA","8","Select","Select",""],["","00310737020","BUDES\/FORMOT","160-4.5","20","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","50111078751","AZITHROMYCIN","250MG","6","Select","Select",""],["","00713063437","MOMETASONE","0.10%","-45","Select","Select",""],["","00173068220","VENTOLIN","","18","Select","Select",""],["","00186037020","SYMBICORT","160-4.5","-20","Select","Select",""],["","00143924920","AMOX\/K","875-125","20","Select","Select",""],["","49281042050","FLUZONE","2020-21","0","Select","Select",""],["","00143992701","CIPROFLOXACN","250MG","14","Select","Select",""],["","68382080601","TRAZODONE ","100MG","30","Select","Select",""],["","69097084507","CYCLOBENZAPR ","5MG","30","Select","Select",""],["","64380073706","VITAMIN ","50000UNT","4","Select","Select",""],["","00591288601","VERAPAMIL ","360MG SR","30","Select","Select",""],["","68382009605","HYDROXYCHLOR ","200MG","30","Select","Select",""],["","00186091612","PULMICORT ","180MCG","1","Select","Select",""],["","00172572970","FAMOTIDINE ","40MG","30","Select","Select",""],["","00093317431","ALBUTEROL ","HFA","8","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","69097012203","TOPIRAMATE ","25MG","100","Select","Select",""],["","62332014231","CELECOXIB ","200MG","30","Select","Select",""],["","00173068220","VENTOLIN ","","18","Select","Select",""],["","00591352530","LIDOCAINE ","5%","-30","Select","Select",""],["","00186037020","SYMBICORT ","160-4.5","-20","Select","Select",""],["","49281042050","FLUZONE ","2020-21","0","Select","Select",""],["","00310737020","BUDES\/FORMOT ","160-4.5","20","Select","Select",""],["","59746000103","METHYLPRED ","4MG","21","Select","Select",""],["","68382004001","PROMETHAZINE ","12.5MG","16","Select","Select",""],["","50111078751","AZITHROMYCIN ","250MG","6","Select","Select",""],["","00143924920","AMOX\/K ","875-125","20","Select","Select",""],["","00713063415","MOMETASONE ","0.10%","45","Select","Select",""],["","50742061510","METOPROL ","25MG ER","90","Select","Select",""],["","00143992701","CIPROFLOXACN ","250MG","14","Select","Select",""],["","50742061510","METOPROL","25MG ER","90","Select","Select",""],["","51267089099","CONTRAVE","8-90MG","70","Select","Select",""],["","51267089099","CONTRAVE ","TAB 8-90MG","70","Select","Select",""],["","80777027399","MODERNA ","INJ COVID-19","0","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":""}]}]}