{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ANNY   R FIGUEREO","gend":1,"add":"6033 STEEPLECHASE LN","city":"SUFFOLK","state":"VA","zip":"23435-9998","dob":"1958-04-30","age":"","mstatus":"","insh":"1682069*02","cliId":"","pno":"757\/686-4731","cno":"757\/686-4731","email":"","ename":"","eno":"","pphy":"RILES JR, NATHAN L MD","ppno":"757\/424-4442","pcpadd":"6632 INDIAN RIVER RD","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23464,"pcpcounty":"","pcpid":122066,"pcpname":"Nowcare Medical Associates","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/623-4765","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M19.072","M19.071","M25.472","I10.","F34.1","R73.9","E78.5","R41.3","F41.1","F32.9","G47.09","G47.33","F32.1","M77.11","K30.","K58.1","Z86.010","R07.9","Z20.828","R07.0","Z12.4","R07.89","M06.30","R73.03","R47.89","R90.82","M25.50","R09.02","M25.471","Z12.31","R10.11","R10.13","N30.90","M54.9","K80.20","R10.9","Z90.49","K80.12","G47.30","K21.9","M19.90","M79.7","K81.1"],"date":["2020-09-15","2020-09-15","2021-01-29","2020-03-02","2020-03-02","2020-03-02","2021-08-02","2021-02-12","2021-02-12","2021-02-12","2021-02-12","2021-05-27","2020-10-13","2021-02-25","2021-07-14","2021-07-14","2021-07-14","2020-02-03","2020-12-01","2020-12-01","2020-12-21","2020-03-09","2020-03-09","2020-03-09","2020-03-09","2020-08-17","2020-09-15","2020-11-24","2020-09-14","2021-03-02","2021-07-11","2021-07-19","2021-07-14","2021-06-07","2021-08-02","2021-08-02","2021-08-02","2021-08-02","2021-08-02","2021-08-02","2021-08-02","2021-08-02","2021-08-02"],"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":[["","75834002001","VITAMIN","50000UNT","4","Select","Select",""],["","51663000500","OPTIMAL-D","50000UNT","-4","Select","Select",""],["","49035061295","","","90","Select","Select",""],["","45802065078","LORATADINE","10MG","90","Select","Select",""],["","69315090401","LORAZEPAM","0.5MG","45","Select","Select",""],["","00093100301","BUSPIRONE","15MG","90","Select","Select",""],["","16714035101","FLUOXETINE","10MG","30","Select","Select",""],["","62332014131","CELECOXIB","100MG","180","Select","Select",""],["","00168034646","TERCONAZOLE","0.40%","45","Select","Select",""],["","00591079605","SULFASALAZIN","500MG","180","Select","Select",""],["","72205000490","ROSUVASTATIN","20MG","90","Select","Select",""],["","65162083366","DICLOFENAC","1%","-200","Select","Select",""],["","00168025846","CLOTRIM\/BETA","DIPROP","45","Select","Select",""],["","16714069211","FLUCONAZOLE","150MG","1","Select","Select",""],["","00143924920","AMOX\/K","875-125","20","Select","Select",""],["","55111018015","TIZANIDINE","4MG","42","Select","Select",""],["","75834002001","VITAMIN ","50000UNT","4","Select","Select",""],["","51663000500","OPTIMAL-D ","50000UNT","-4","Select","Select",""],["","45802065078","LORATADINE ","10MG","90","Select","Select",""],["","69315090401","LORAZEPAM ","0.5MG","45","Select","Select",""],["","62332014131","CELECOXIB ","100MG","180","Select","Select",""],["","72205000490","ROSUVASTATIN ","20MG","90","Select","Select",""],["","16714035101","FLUOXETINE ","10MG","30","Select","Select",""],["","00093100301","BUSPIRONE ","15MG","-90","Select","Select",""],["","16714069211","FLUCONAZOLE ","150MG","1","Select","Select",""],["","00168034646","TERCONAZOLE ","0.40%","45","Select","Select",""],["","55111018015","TIZANIDINE ","4MG","42","Select","Select",""],["","00591079605","SULFASALAZIN ","500MG","-180","Select","Select",""],["","00143924920","AMOX\/K ","875-125","20","Select","Select",""],["","21922000909","DICLOFENAC ","1%","200","Select","Select",""],["","00143122701","DICYCLOMINE ","20MG","120","Select","Select",""],["","00406051201","OXYCOD\/APAP ","5-325MG","20","Select","Select",""],["","00168025846","CLOTRIM\/BETA ","DIPROP","45","Select","Select",""],["","58657067601","CIPROFLOXACN ","500MG","6","Select","Select",""],["","31722071390","PANTOPRAZOLE ","40MG","28","Select","Select",""],["","58657067601","CIPROFLOXACN","500MG","6","Select","Select",""],["","00143122701","DICYCLOMINE","20MG","120","Select","Select",""],["","31722071390","PANTOPRAZOLE","40MG","28","Select","Select",""],["","49035061246","ALLERGY","10MG","90","Select","Select",""],["","00406051201","OXYCOD\/APAP","5-325MG","20","Select","Select",""],["","43386009019","GAVILYTE-G","","-4000","Select","Select",""],["","00869260508","MAGN","","300","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":""}]}]}