{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"PAT   E VIOLA","gend":0,"add":"232 WENTWORTH CT","city":"SUFFOLK","state":"VA","zip":"23436-9998","dob":"1970-01-03","age":"","mstatus":"","insh":"1641623*02","cliId":"","pno":"757\/238-2674","cno":"757\/238-2674","email":"","ename":"","eno":"","pphy":"GRAVES, NIKKI MD","ppno":"757\/484-7248","pcpadd":"2897 BRIDGE RD","pcpcity":"SUFFOLK","pcpstate":"VA","pcpzip":23435,"pcpcounty":"","pcpid":400077,"pcpname":"NANSEMOND SUFFOLK FAMILY PRACTICE","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"757\/538-3849","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":["G56.03","E11.9","I10.","E78.00","G47.33","E29.1","H92.01","H71.93","R20.2","R51.9","H60.61","E11.65","E53.8","U07.1","Z23.","R94.39","D12.6","E11.40","K76.0","E66.01","H90.6","H66.93","K74.60","R07.2","Z86.16","R19.5","R14.2","K63.5","R20.0","G56.21","R74.8","Z12.11","Z71.3","I25.10","R16.1","J06.9","K59.00","Z20.828","Z00.00","E11.29","R80.9","R05.","M54.2","L82.0","L91.8","L82.1","D18.00","L81.4","Z71.9","E78.5","Z79.82","Z79.3","Z79.899","R06.02","M47.812","R07.89","Z87.891","Z86.69","Z87.01","Z79.84","Z79.890","Z82.49","Z83.3","Z82.5"],"date":["2020-03-03","2021-08-09","2021-05-12","2021-05-12","2020-11-12","2021-03-18","2021-04-02","2021-04-02","2021-04-02","2021-04-02","2021-04-02","2021-04-02","2021-04-02","2021-03-18","2021-03-18","2021-05-12","2021-06-01","2020-05-06","2021-04-14","2021-03-18","2021-09-21","2020-09-21","2020-09-29","2021-03-25","2021-04-14","2021-06-01","2021-06-01","2021-06-01","2020-02-27","2020-02-27","2020-09-29","2020-11-12","2020-09-10","2021-04-14","2020-09-29","2021-01-15","2021-04-19","2021-01-23","2020-11-12","2021-03-18","2021-03-18","2021-01-14","2021-04-02","2020-03-10","2020-03-10","2020-03-10","2020-03-10","2020-03-10","2020-03-10","2021-04-14","2021-04-14","2021-03-25","2021-04-14","2021-03-25","2021-04-02","2021-04-14","2021-04-14","2021-04-14","2021-04-14","2021-04-14","2021-04-14","2021-04-14","2021-04-14","2021-04-14"],"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":[["","00006027731","JANUVIA","100MG","90","Select","Select",""],["","68180051303","LISINOPRIL","5MG","90","Select","Select",""],["","51224000760","METFORMIN","500MG ER","360","Select","Select",""],["","00597015330","JARDIANCE","25MG","-30","Select","Select",""],["","69452015120","VITAMIN","50000UNT","-12","Select","Select",""],["","00169406012","VICTOZA","18MG\/3ML","9","Select","Select",""],["","00065853302","CIPRODEX","0.3-0.1%","8","Select","Select",""],["","55111012305","ATORVASTATIN","40MG","90","Select","Select",""],["","53885039310","ONETOUCH","LANCETS","100","Select","Select",""],["","69238161606","OFLOXACIN","0.3%OTIC","10","Select","Select",""],["","60505082901","FLUTICASONE","50MCG","16","Select","Select",""],["","43598043611","NITROGLYCERN","0.4MG","25","Select","Select",""],["","00378001805","METOPROL","25MG","-180","Select","Select",""],["","31722071030","SILDENAFIL","50MG","10","Select","Select",""],["","00006027731","JANUVIA ","100MG","90","Select","Select",""],["","68180051303","LISINOPRIL ","5MG","90","Select","Select",""],["","51224000760","METFORMIN ","500MG ER","360","Select","Select",""],["","69452015120","VITAMIN ","50000UNT","12","Select","Select",""],["","00597015330","JARDIANCE ","25MG","-30","Select","Select",""],["","55111012305","ATORVASTATIN ","40MG","90","Select","Select",""],["","00169406012","VICTOZA ","18MG\/3ML","3","Select","Select",""],["","31722071030","SILDENAFIL ","50MG","10","Select","Select",""],["","00065853302","CIPRODEX ","0.3-0.1%","8","Select","Select",""],["","53885039310","ONETOUCH ","LANCETS","100","Select","Select",""],["","43598043611","NITROGLYCERN ","0.4MG","-25","Select","Select",""],["","69238161606","OFLOXACIN ","0.3%OTIC","10","Select","Select",""],["","60505082901","FLUTICASONE ","50MCG","-16","Select","Select",""],["","00378001805","METOPROL ","25MG","180","Select","Select",""],["","00363000703","OMEPRAZOLE ","20MG","30","Select","Select",""],["","00363000703","OMEPRAZOLE","20MG","30","Select","Select",""],["","00781618667","CIPRO\/DEXA","0.3-0.1%","8","Select","Select",""],["","31722072690","MONTELUKAST","10MG","-30","Select","Select",""],["","00781618667","CIPRO\/DEXA ","SUS 0.3-0.1%","8","Select","Select",""],["","31722072690","MONTELUKAST ","TAB 10MG","-30","Select","Select",""],["","56151147002","TRUE ","KIT METER","1","Select","Select",""],["","11917015021","LANCETS ","MIS THIN 28G","100","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":""}]}]}