{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"PATRICE DYKES","gend":1,"add":"428 FOREST RD","city":"CHESAPEAKE","state":"VA","zip":"23322-9998","dob":"1970-08-03","age":"","mstatus":"","insh":"1556928*02","cliId":"","pno":"757\/374-7298","cno":"757\/374-7298","email":"","ename":"","eno":"","pphy":"GONZALES, NORMAN M MD","ppno":"757\/413-7600","pcpadd":"SUITE 301 5320 PROVIDENCE RD","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23464,"pcpcounty":"","pcpid":450016,"pcpname":"SMG - Resource Pool","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"757\/482-2282","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J20.9","J01.00","J30.1","H90.5","J01.91","R51.","J45.998","K21.9","Z12.4","G43.709","I10.","Z68.32","J06.9","Z11.59","E55.9","R00.2","J30.2","Z12.31","R51.9","Z20.822","G43.009","Z12.39","J98.01","Z00.00","Z23.","Z12.11","M79.671","R21.","Z01.419","Z30.40","Z82.0","J98.8","J30.0","J01.11","R05.","R09.81","H92.09","R52.","J02.9","R06.83","H90.0","Z30.41","G57.61","M20.11","M77.41","G47.10","G47.33"],"date":["2020-02-24","2020-02-24","2021-07-23","2020-06-26","2020-06-26","2020-06-26","2021-07-01","2021-07-01","2021-07-20","2021-02-15","2021-05-03","2021-02-15","2021-01-08","2021-05-03","2021-05-03","2021-05-03","2021-07-01","2021-07-20","2021-07-01","2021-01-18","2021-05-03","2020-04-28","2020-04-28","2020-10-26","2021-05-03","2021-07-20","2021-05-03","2021-05-03","2021-07-20","2020-06-17","2020-08-05","2020-06-04","2021-07-01","2020-12-28","2020-12-28","2020-12-28","2021-01-18","2021-06-16","2021-01-18","2021-07-01","2021-07-01","2021-07-20","2021-06-16","2021-06-16","2021-06-16","2021-07-26","2021-07-26"],"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":[["","67877026118","RIZATRIPTAN","5MG","12","Select","Select",""],["","00173068220","VENTOLIN","","18","Select","Select",""],["","68180059101","RAMIPRIL","10MG","90","Select","Select",""],["","65862039110","ONDANSETRON","8MG ODT","27","Select","Select",""],["","70710113908","FLUCONAZOLE","150MG","1","Select","Select",""],["","45802002683","AZELASTINE","0.15%","30","Select","Select",""],["","00555902658","JUNEL","20-Jan","84","Select","Select",""],["","69097012203","TOPIRAMATE","25MG","60","Select","Select",""],["","55513084301","AIMOVIG","140MG\/ML","1","Select","Select",""],["","53489011905","DOXYCYCL","100MG","20","Select","Select",""],["","00093742698","MONTELUKAST","10MG","90","Select","Select",""],["","00093770198","LEVOCETIRIZI","5MG","90","Select","Select",""],["","24208039915","IPRATROPIUM","0.06%","15","Select","Select",""],["","65162055310","METAXALONE","800MG","30","Select","Select",""],["","67877057305","BENZONATATE","100MG","40","Select","Select",""],["","58160082311","SHINGRIX","50\/0.5ML","1","Select","Select",""],["","65862050320","AMOX\/K","875-125","-20","Select","Select",""],["","59746000103","METHYLPRED","4MG","-21","Select","Select",""],["","11534018701","BUT\/APAP\/CAF","","20","Select","Select",""],["","00002143611","EMGALITY","120MG\/ML","1","Select","Select",""],["","00054327099","FLUTICASONE","50MCG","48","Select","Select",""],["","00378064110","PREDNISONE","10MG","28","Select","Select",""],["","75834015801","VERAPAMIL","180MG ER","-30","Select","Select",""],["","00172392670","DIAZEPAM","5MG","3","Select","Select",""],["","33332032001","AFLURIA","2020-21","0","Select","Select",""],["","68180016013","AZITHROMYCIN","250MG","6","Select","Select",""],["","66993001968","ALBUTEROL","HFA","18","Select","Select",""],["","70710122501","AMITRIPTYLIN","10MG","30","Select","Select",""],["","00173068220","VENTOLIN ","","18","Select","Select",""],["","65862039110","ONDANSETRON ","8MG ODT","27","Select","Select",""],["","67877026118","RIZATRIPTAN ","5MG","12","Select","Select",""],["","68180059101","RAMIPRIL ","10MG","90","Select","Select",""],["","65162055310","METAXALONE ","800MG","30","Select","Select",""],["","53489011905","DOXYCYCL ","100MG","20","Select","Select",""],["","67877057305","BENZONATATE ","100MG","30","Select","Select",""],["","00555902658","JUNEL ","20-Jan","84","Select","Select",""],["","00093742698","MONTELUKAST ","10MG","90","Select","Select",""],["","70710113908","FLUCONAZOLE ","150MG","1","Select","Select",""],["","00378064110","PREDNISONE ","10MG","28","Select","Select",""],["","00172392670","DIAZEPAM ","5MG","3","Select","Select",""],["","00093770198","LEVOCETIRIZI ","5MG","90","Select","Select",""],["","45802002683","AZELASTINE ","0.15%","30","Select","Select",""],["","69097012203","TOPIRAMATE ","25MG","60","Select","Select",""],["","55513084301","AIMOVIG ","140MG\/ML","1","Select","Select",""],["","24208039915","IPRATROPIUM ","0.06%","15","Select","Select",""],["","33332032001","AFLURIA ","2020-21","0","Select","Select",""],["","58160082311","SHINGRIX ","50\/0.5ML","-1","Select","Select",""],["","65862050320","AMOX\/K ","875-125","20","Select","Select",""],["","59746000103","METHYLPRED ","4MG","-21","Select","Select",""],["","11534018701","BUT\/APAP\/CAF ","","20","Select","Select",""],["","75834015801","VERAPAMIL ","180MG ER","30","Select","Select",""],["","00002143611","EMGALITY ","120MG\/ML","1","Select","Select",""],["","66993001968","ALBUTEROL ","HFA","18","Select","Select",""],["","70710122501","AMITRIPTYLIN ","10MG","30","Select","Select",""],["","68180016013","AZITHROMYCIN ","250MG","6","Select","Select",""],["","00054327099","FLUTICASONE ","50MCG","48","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":""}]}]}