{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"NAOMI   E FASULO","gend":1,"add":"1141 LOWLAND COTTAGE LN","city":"VIRGINIA BEACH","state":"VA","zip":"23454-9998","dob":"1961-05-18","age":"","mstatus":"","insh":"1672287*01","cliId":"","pno":"757\/644-7844","cno":"757\/644-7844","email":"","ename":"","eno":"","pphy":"REED, SHARON B MD","ppno":"757\/622-8358","pcpadd":"930 W 21ST ST SUITE 100","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23517,"pcpcounty":"","pcpid":156143,"pcpname":"","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"757\/340-9781","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":["M25.519","B19.20","M06.9","Z00.00","Z22.7","M05.9","E78.5","R73.03","M75.02","S90.111S","M05.79","K73.9","Z91.19","F17.200","Z22.1","L20.9","Z00.01","J32.9","Z03.818","Z11.59","Z12.11","R76.11","E55.9","Z01.419"],"date":["2020-04-01","2020-05-13","2021-06-29","2020-05-13","2020-12-22","2021-01-20","2021-06-29","2020-05-13","2020-05-13","2020-05-13","2020-12-22","2020-12-22","2020-12-22","2021-06-29","2020-04-14","2020-08-17","2021-06-17","2020-02-10","2020-07-01","2020-07-01","2020-08-31","2021-06-29","2021-06-29","2021-06-29"],"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":[["","58657050016","CODEINE\/GG","10-100\/5","60","Select","Select",""],["","00069047103","CHANTIX","0.5& 1MG","53","Select","Select",""],["","58406003204","ENBREL","50MG\/ML","4","Select","Select",""],["","00093005805","TRAMADOL","50MG","40","Select","Select",""],["","68180016013","AZITHROMYCIN","250MG","6","Select","Select",""],["","00228202750","ALPRAZOLAM","0.25MG","60","Select","Select",""],["","00378064110","PREDNISONE","10MG","20","Select","Select",""],["","00555007102","ISONIAZID","300MG","30","Select","Select",""],["","65162019050","NAPROXEN","500MG","180","Select","Select",""],["","69452015120","VITAMIN","50000UNT","-12","Select","Select",""],["","63304069301","CLINDAMYCIN","300MG","21","Select","Select",""],["","59267100002","PFIZER","COVID-19","0","Select","Select",""],["","60505384901","CELECOXIB","200MG","30","Select","Select",""],["","00069047103","CHANTIX ","0.5& 1MG","-53","Select","Select",""],["","68180016013","AZITHROMYCIN ","250MG","-5","Select","Select",""],["","58406003204","ENBREL ","50MG\/ML","4","Select","Select",""],["","58657050016","CODEINE\/GG ","10-100\/5","60","Select","Select",""],["","00228202750","ALPRAZOLAM ","0.25MG","60","Select","Select",""],["","00093005805","TRAMADOL ","50MG","12","Select","Select",""],["","00378064110","PREDNISONE ","10MG","17","Select","Select",""],["","65162019050","NAPROXEN ","500MG","180","Select","Select",""],["","63304069301","CLINDAMYCIN ","300MG","21","Select","Select",""],["","00555007102","ISONIAZID ","300MG","30","Select","Select",""],["","60505384901","CELECOXIB ","200MG","30","Select","Select",""],["","59267100002","PFIZER ","COVID-19","0","Select","Select",""],["","69452015120","VITAMIN ","50000UNT","12","Select","Select",""],["","00093226301","AMOXICILLIN ","500MG","21","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":""}]}]}