{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DAVID   PAXTON BUCKINGHAM","gend":0,"add":"1157 SURREY CRES","city":"NORFOLK","state":"VA","zip":"23508-9998","dob":"1981-06-17","age":"","mstatus":"","insh":"1694605*01","cliId":"","pno":"757\/286-4116","cno":"757\/286-4116","email":"","ename":"","eno":"","pphy":"DESHMUKH, PRAVIN M MD","ppno":"757\/278-2240","pcpadd":"155 KINGSLEY LANE SUITE 400","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23505,"pcpcounty":"","pcpid":142722,"pcpname":"BON SECOURS SHORT PUMP PRIMARY CARE","plan":"OHP","program":"ACA","lob":"Individual","region":"TIDEWATER","aligned":"","ano":"757\/286-4116","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/489-6469","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["B20.","Z51.81","Z79.890","E78.5","Z23.","G47.419","M51.36","M48.061","M51.26","M47.816","M25.562","M25.561","M25.521","M77.11","L29.1","M54.5","L72.9","R23.4","Z71.9","G47.411","Z11.3","Z13.220","L73.8","L21.9","M25.569","G89.29","M54.9","M25.511","Z00.00","G57.91","M79.674","L70.8","L82.1","J02.9","M54.59","L70.9"],"date":["2021-09-27","2020-10-21","2020-10-21","2020-10-21","2020-11-11","2021-06-23","2020-06-06","2020-06-06","2020-06-06","2020-06-06","2020-02-13","2020-02-13","2021-10-04","2021-06-09","2020-11-11","2021-09-01","2021-02-10","2021-02-04","2021-10-05","2021-04-19","2021-04-19","2021-04-19","2020-01-30","2021-10-05","2020-01-30","2020-06-06","2020-06-03","2020-06-03","2020-06-03","2021-02-18","2021-02-18","2020-07-01","2020-07-01","2021-06-16","2021-10-04","2021-10-05"],"priorHcc":[null,"","","","","","","","","","","",null,"","",null,"","",null,"","","","",null,"","","","","","","","","","",null,null]}},{"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":[["","68727010001","XYREM","500MG\/ML","360","Select","Select",""],["","61958210101","ODEFSEY","","30","Select","Select",""],["","65862060201","MODAFINIL","200MG","60","Select","Select",""],["","51672139509","TRETINOIN","0.10%","-45","Select","Select",""],["","45802046564","KETOCONAZOLE","2%","240","Select","Select",""],["","00406889301","AMPHET\/DEXTR","20MG","60","Select","Select",""],["","69238110005","DOXYCYCL","100MG","-60","Select","Select",""],["","72028017803","WAKIX","17.8MG","14","Select","Select",""],["","68462019001","NAPROXEN","500MG","60","Select","Select",""],["","45802027603","HYDROCORT","1%","28","Select","Select",""],["","61958250101","BIKTARVY","","-30","Select","Select",""],["","11822314320","RA","1%","28","Select","Select",""],["","68727015001","XYWAV","0.5GM\/ML","540","Select","Select",""],["","59267100002","PFIZER","COVID-19","0","Select","Select",""],["","68727010001","XYREM ","500MG\/ML","-360","Select","Select",""],["","68462019001","NAPROXEN ","500MG","60","Select","Select",""],["","45802046564","KETOCONAZOLE ","2%","-240","Select","Select",""],["","61958210101","ODEFSEY ","","-30","Select","Select",""],["","65862060201","MODAFINIL ","200MG","-60","Select","Select",""],["","51672139509","TRETINOIN ","0.10%","-45","Select","Select",""],["","00406889301","AMPHET\/DEXTR ","20MG","60","Select","Select",""],["","69238110005","DOXYCYCL ","100MG","60","Select","Select",""],["","72028004503","WAKIX ","4.45MG","-14","Select","Select",""],["","61958250101","BIKTARVY ","","30","Select","Select",""],["","45802027603","HYDROCORT ","1%","28","Select","Select",""],["","11822314320","RA ","1%","28","Select","Select",""],["","68727015001","XYWAV ","0.5GM\/ML","540","Select","Select",""],["","59267100002","PFIZER ","COVID-19","0","Select","Select",""],["","58160088752","FLUARIX ","INJ 2021-22","0","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","",""],["No","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":""}]}]}