{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MARTHA   WIMETT LOZIER","gend":1,"add":"1036 WASHINGTON DR","city":"CHESAPEAKE","state":"VA","zip":"23322-9998","dob":"1958-11-15","age":"","mstatus":"","insh":"1720517*01","cliId":"","pno":"757\/621-0603","cno":"757\/621-0603","email":"","ename":"","eno":"","pphy":"SHICK, DEVON MD","ppno":"757\/842-6180","pcpadd":"SUITE 101 1419 CEDAR ROAD","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":23322,"pcpcounty":"","pcpid":146583,"pcpname":"Cedar Road Medical Associates","plan":"OHP","program":"ACA","lob":"Individual","region":"TIDEWATER","aligned":"","ano":"757\/621-0603","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":["Z43.3","M06.4","M85.80","K57.20","Z79.899","D18.09","Z12.31","Z00.00","M54.5","S93.401D","I10.","E78.5","K59.00","J32.9","F41.8","E55.9","K11.7","J90.","M54.12","M06.9","R41.3","M05.9","M47.812","M50.30","M46.90","M43.13","Z12.11","Z01.419","K57.92","E61.1","E78.00","R19.4","E87.1","M81.0","D18.03","I31.3","R18.8","Z93.3","M19.90","R94.6","R19.7","H40.9","R94.5","H40.023","H52.13","H52.4","K22.4","K44.9","R53.83","S93.401A","M25.811","M25.511","Z91.81","R13.10","R09.89","R29.6","M48.07","M47.817","M54.40","T14.90XA","Z83.71","K76.89","M50.10","M47.22","M53.2X2","M53.2X3","M25.519","M47.816","M43.16","M16.11","M43.12","M54.2","I36.1"],"date":["2021-08-26","2021-09-17","2021-09-17","2021-09-17","2021-09-17","2020-12-31","2021-06-11","2020-08-21","2021-09-14","2021-09-14","2021-09-03","2021-09-03","2021-06-15","2021-06-11","2021-09-03","2021-09-03","2021-06-15","2021-09-07","2021-09-03","2021-09-03","2021-09-03","2020-09-18","2021-08-27","2020-08-21","2021-06-18","2020-08-21","2021-05-23","2020-09-25","2020-12-31","2021-06-15","2020-12-31","2020-12-22","2020-12-22","2020-12-22","2021-06-04","2021-09-07","2020-12-31","2021-09-03","2020-12-31","2020-03-13","2020-03-13","2020-03-13","2020-03-13","2021-03-16","2021-03-16","2021-03-16","2021-04-23","2021-07-16","2020-08-28","2020-08-27","2020-08-18","2021-06-18","2020-08-21","2021-09-03","2021-04-23","2020-07-30","2020-08-07","2020-08-07","2020-08-18","2020-08-18","2021-03-25","2021-03-25","2021-06-18","2021-06-18","2021-06-29","2021-06-18","2021-06-18","2020-08-07","2020-08-07","2020-09-18","2021-08-27","2021-11-18","2021-09-07"],"priorHcc":["","",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":[["","70377002911","ATORVASTATIN","40MG","30","Select","Select",""],["","68180072003","AMLODIPINE","5MG","30","Select","Select",""],["","50474071079","CIMZIA","200MG\/ML","1","Select","Select",""],["","51991070605","ALPRAZOLAM","1MG","90","Select","Select",""],["","00093078701","ATENOLOL","25MG","30","Select","Select",""],["","65162062750","TRAMADOL","50MG","60","Select","Select",""],["","13668013710","ESCITALOPRAM","20MG","30","Select","Select",""],["","69097022416","ALENDRONATE","70MG","12","Select","Select",""],["","55111057503","IBANDRONATE","150MG","-3","Select","Select",""],["","49281072010","FLUBLOK","2020-21","0","Select","Select",""],["","68180072003","AMLODIPINE ","5MG","30","Select","Select",""],["","70377002911","ATORVASTATIN ","40MG","30","Select","Select",""],["","51991070605","ALPRAZOLAM ","1MG","90","Select","Select",""],["","50474071079","CIMZIA ","200MG\/ML","1","Select","Select",""],["","00093078701","ATENOLOL ","25MG","30","Select","Select",""],["","13668013710","ESCITALOPRAM ","20MG","30","Select","Select",""],["","69097022416","ALENDRONATE ","70MG","12","Select","Select",""],["","65162062750","TRAMADOL ","50MG","21","Select","Select",""],["","49281072010","FLUBLOK ","2020-21","0","Select","Select",""],["","55111057503","IBANDRONATE ","150MG","-3","Select","Select",""],["","00115174801","METAXALONE","800MG","30","Select","Select",""],["","80777027398","MODERNA","COVID-19","0","Select","Select",""],["","00115174801","METAXALONE ","TAB 800MG","-30","Select","Select",""],["","80777027398","MODERNA ","INJ COVID-19","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","",""],["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":""}]}]}