{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KENNETH   WAYNE FRANKLIN JR","gend":0,"add":"3 BLACKWATER LN","city":"HAMPTON","state":"VA","zip":"23669-9998","dob":"1979-04-08","age":"","mstatus":"","insh":"1519134*01","cliId":"","pno":"757\/604-2966","cno":"757\/604-2966","email":"","ename":"","eno":"","pphy":"CLIFFORD, GREGG R MD","ppno":"757\/252-9300","pcpadd":"STE 900 301 RIVERVIEW AVE","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23510,"pcpcounty":"","pcpid":161498,"pcpname":"SMG - Dedicated Care Center","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/510-9278","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["S42.254D","Z20.828","E83.110","Z00.00","I10.","E78.00","Z12.5","E55.9","Z20.2","N52.9","K21.9","R07.2","R55.","R20.8","F43.0","S42.254A","Y93.02","W01.0XXA","Y92.480","J01.21","J01.01","J32.2","J32.0","J30.89","R09.81","R09.82","Z91.040","R61.","S42.201A","S80.211A","S93.402A","J06.9","S61.220A","J02.0","J31.0","J34.2","J34.3","R51.9","J01.90","B96.89","E66.9","F09.","M10.09","K58.0","R41.0","R41.89","E66.09"],"date":["2020-05-15","2021-02-01","2021-09-01","2021-08-04","2021-09-01","2021-09-01","2020-10-30","2020-10-30","2021-09-01","2020-10-30","2021-09-01","2020-02-20","2020-02-20","2020-02-20","2020-02-20","2020-04-08","2020-04-08","2020-04-08","2020-04-08","2021-07-20","2021-07-20","2021-07-20","2021-08-11","2021-07-20","2021-07-13","2021-02-16","2020-02-05","2020-02-05","2020-04-07","2020-04-07","2020-04-07","2021-02-01","2021-04-01","2021-05-22","2021-02-01","2021-07-20","2021-07-20","2021-08-11","2021-07-07","2021-07-07","2021-07-13","2021-08-11","2021-09-01","2021-08-04","2021-08-11","2021-08-11","2021-09-01"],"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":[["","70710120901","ALLOPURINOL","100MG","90","Select","Select",""],["","33342017807","OLMESA","5MG","180","Select","Select",""],["","00591024105","LORAZEPAM","1MG","30","Select","Select",""],["","60505095303","AZEL\/FLUTIC","137-50","-23","Select","Select",""],["","59762040101","SUCRALFATE","1GM","-60","Select","Select",""],["","67877032105","IBUPROFEN","800MG","30","Select","Select",""],["","13107005999","APAP\/CODEINE","300-30MG","15","Select","Select",""],["","65862019105","CYCLOBENZAPR","10MG","30","Select","Select",""],["","00363092953","WAL-ZYR","5-120MG","180","Select","Select",""],["","10702002501","PHENTERMINE","37.5MG","30","Select","Select",""],["","50580072824","ZYRTEC-D","5-120MG","180","Select","Select",""],["","45802006435","TRIAMCINOLON","0.10%","15","Select","Select",""],["","42571016242","AMOX\/K","875-125","20","Select","Select",""],["","65862053750","LEVOFLOXACIN","500MG","10","Select","Select",""],["","68180016106","AZITHROMYCIN","500MG","2","Select","Select",""],["","59746000103","METHYLPRED","4MG","21","Select","Select",""],["","50383077504","LIDOCAINE","2% VISC","100","Select","Select",""],["","00143993905","AMOXICILLIN","500MG","30","Select","Select",""],["","33342017807","OLMESA ","5MG","180","Select","Select",""],["","70710120901","ALLOPURINOL ","100MG","90","Select","Select",""],["","59762040101","SUCRALFATE ","1GM","60","Select","Select",""],["","00591024105","LORAZEPAM ","1MG","30","Select","Select",""],["","60505095303","AZEL\/FLUTIC ","137-50","-23","Select","Select",""],["","67877032105","IBUPROFEN ","800MG","30","Select","Select",""],["","13107005999","APAP\/CODEINE ","300-30MG","15","Select","Select",""],["","65862019105","CYCLOBENZAPR ","10MG","30","Select","Select",""],["","00363092953","WAL-ZYR ","5-120MG","180","Select","Select",""],["","50580072824","ZYRTEC-D ","5-120MG","180","Select","Select",""],["","10702002501","PHENTERMINE ","37.5MG","30","Select","Select",""],["","68180016106","AZITHROMYCIN ","500MG","2","Select","Select",""],["","50383077504","LIDOCAINE ","2% VISC","100","Select","Select",""],["","59746000103","METHYLPRED ","4MG","21","Select","Select",""],["","65862053750","LEVOFLOXACIN ","500MG","10","Select","Select",""],["","45802006435","TRIAMCINOLON ","0.10%","-15","Select","Select",""],["","00143993905","AMOXICILLIN ","500MG","30","Select","Select",""],["","08290309702","3ML ","LUER-LOK","-10","Select","Select",""],["","08290309623","1ML ","27GX1\/2\"","-10","Select","Select",""],["","00641614525","DEXAMETH ","4MG\/ML","10","Select","Select",""],["","68180030360","CEFUROXIME ","500MG","20","Select","Select",""],["","63323001094","GENTAMICIN ","40MG\/ML","10","Select","Select",""],["","11822505410","RA ","5-120MG","168","Select","Select",""],["","65862015901","ZOLPIDEM ","5MG","30","Select","Select",""],["","42571016242","AMOX\/K ","875-125","20","Select","Select",""],["","65162071009","COLCHICINE ","0.6MG","30","Select","Select",""],["","60505612902","BUDESONIDE ","32MCG","8","Select","Select",""],["","68180030360","CEFUROXIME","500MG","20","Select","Select",""],["","63323001094","GENTAMICIN","40MG\/ML","10","Select","Select",""],["","08290309702","3ML","LUER-LOK","-10","Select","Select",""],["","11822505410","RA","5-120MG","168","Select","Select",""],["","00641614525","DEXAMETH","4MG\/ML","10","Select","Select",""],["","08290309623","1ML","27GX1\/2\"","10","Select","Select",""],["","65162071009","COLCHICINE","0.6MG","30","Select","Select",""],["","60505612902","BUDESONIDE","32MCG","8","Select","Select",""],["","65862015901","ZOLPIDEM","5MG","30","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","",""],["No","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":""}]}]}