{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SHARI   L ASHMORE","gend":1,"add":"9512 7TH BAY ST","city":"NORFOLK","state":"VA","zip":"23518-9998","dob":"1962-11-21","age":"","mstatus":"","insh":"1534784*02","cliId":"","pno":"757\/553-1104","cno":"757\/553-1104","email":"","ename":"","eno":"","pphy":"BEAVERS, TAMMY J MD","ppno":"757\/838-6335","pcpadd":"9 MANHATTAN SQUARE STE A","pcpcity":"HAMPTON","pcpstate":"VA","pcpzip":23666,"pcpcounty":"","pcpid":410067,"pcpname":"Hampton Family Practice, PLLC","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"757\/676-2664, ","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/838-0612","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E11.9","Z00.00","Z12.11","D12.5","D12.3","Z80.0","M06.09","Z79.899","Z12.4","I20.9","R94.30","I10.","Z12.31","F41.3","M05.79","K21.9","Z20.828","M79.642","M79.641","M20.12","M77.32","M20.11","M77.31","M19.041","M19.071","M19.042","M19.072","R07.9","R07.89","E78.00","F32.9","F41.9","G47.00","Z79.84","Z79.1","Z88.0","Z80.49","Z83.3","Z82.49","R94.39","M06.9","Z03.818","M26.609","F41.1","R10.9","R10.13","M15.9","Z98.890"],"date":["2021-07-21","2020-05-11","2020-06-04","2020-06-04","2020-06-04","2021-04-02","2021-06-22","2021-06-22","2020-05-20","2021-04-16","2021-04-16","2021-04-16","2021-06-25","2021-05-17","2021-03-16","2021-04-02","2020-11-10","2021-06-17","2021-06-17","2021-06-22","2021-06-17","2021-06-22","2021-06-17","2021-06-22","2021-06-22","2021-06-22","2021-06-22","2021-04-07","2021-04-02","2021-04-02","2021-04-02","2021-04-02","2021-04-07","2021-04-02","2021-04-02","2021-04-02","2021-04-02","2021-04-02","2021-04-02","2021-04-02","2021-06-17","2020-07-20","2020-09-10","2021-04-07","2021-03-10","2021-03-10","2021-06-17","2020-06-17"],"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":[["","65862001230","SERTRALINE","50MG","90","Select","Select",""],["","16571069809","LANSOPRAZOLE ","30MG DR","-180","Select","Select",""],["","68180063609","ATORVASTATIN ","20MG","-90","Select","Select",""],["","59762010401","SULFASALAZIN ","500MG DR","-360","Select","Select",""],["","67877056105","METFORMIN ","500MG","180","Select","Select",""],["","00074055402","HUMIRA ","40\/0.4ML","-2","Select","Select",""],["","13668010401","ISOSORB ","30MG ER","-30","Select","Select",""],["","69315012701","FOLIC ","1000MCG","90","Select","Select",""],["","50742061701","METOPROL ","100MG ER","-135","Select","Select",""],["","16729013616","CLONAZEPAM ","0.5MG","30","Select","Select",""],["","00054455015","METHOTREXATE ","2.5MG","96","Select","Select",""],["","65862001230","SERTRALINE ","50MG","90","Select","Select",""],["","68462063945","NITROGLYCERN ","0.4MG","25","Select","Select",""],["","59746021106","CYCLOBENZAPR ","5MG","30","Select","Select",""],["","58160088552","FLUARIX ","2020-21","0","Select","Select",""],["","00006483703","PNEUMOVAX ","25\/0.5","0","Select","Select",""],["","59762444002","METHYLPRED ","4MG","21","Select","Select",""],["","62332001131","VENLAFAXINE ","75MG","90","Select","Select",""],["","65862015901","ZOLPIDEM ","5MG","20","Select","Select",""],["","59762010401","SULFASALAZIN","500MG DR","-360","Select","Select",""],["","60505257909","ATORVASTATIN","20MG","90","Select","Select",""],["","16729013616","CLONAZEPAM","0.5MG","60","Select","Select",""],["","67877056105","METFORMIN","500MG","180","Select","Select",""],["","00054455015","METHOTREXATE","2.5MG","28","Select","Select",""],["","65162036110","FOLIC","1MG","90","Select","Select",""],["","59762444002","METHYLPRED","4MG","21","Select","Select",""],["","62332001131","VENLAFAXINE","75MG","90","Select","Select",""],["","50742061701","METOPROL","100MG ER","-135","Select","Select",""],["","59746021106","CYCLOBENZAPR","5MG","30","Select","Select",""],["","00074055402","HUMIRA","40\/0.4ML","-2","Select","Select",""],["","58160088552","FLUARIX","2020-21","0","Select","Select",""],["","00006483703","PNEUMOVAX","25\/0.5","0","Select","Select",""],["","00378803077","LANSOPRAZOLE","30MG DR","60","Select","Select",""],["","68462063945","NITROGLYCERN","0.4MG","50","Select","Select",""],["","13668010401","ISOSORB","30MG ER","-30","Select","Select",""],["","65862015901","ZOLPIDEM","5MG","20","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":[[["Yes","Select","","","","","Select","",""],["Yes","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":""}]}]}