{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DEBORAH   ANNE KEANE","gend":1,"add":"718 JAMESTOWN ROAD","city":"WILLIAMSBURG","state":"VA","zip":"23185-9998","dob":"1958-09-13","age":"","mstatus":"","insh":"1749534*01","cliId":"","pno":"757\/229-8580","cno":"757\/229-8580","email":"","ename":"","eno":"","pphy":"BLANCHARD, JEFFREY G MD","ppno":"757\/707-3669","pcpadd":"132 PROFESSIONAL CIRCLE","pcpcity":"WILLIAMSBURG","pcpstate":"VA","pcpzip":23185,"pcpcounty":"","pcpid":157538,"pcpname":"WILLIAMSBURG FAMILY MEDICINE","plan":"OHP","program":"ACA","lob":"Individual","region":"TIDEWATER","aligned":"","ano":"757\/208-9023","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/903-4304","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R06.09","K57.32","R10.30","R19.7","K57.30","K57.92","K58.9","K90.0","E78.5","E03.9","R10.814","Z88.1","Z79.899","Z79.890","Z87.891","N81.10","I82.890","E87.6","K76.89","R10.2","R11.0","R10.32","J84.10","Z90.2","Z20.822","I28.0","E78.00","E87.1","Z48.813","K59.04","R06.00","N81.11","N81.2","E07.9","Z82.49","R68.83","R39.9","J34.89","R91.8","R32.","R39.14","R15.0","N81.3","N95.2","K59.00","R10.9","Z20.828","E55.9","Z46.6","Z96.0","M25.551","Z85.118","R07.89","Z98.890"],"date":["2020-02-11","2020-03-05","2020-03-11","2020-03-11","2020-03-05","2020-03-05","2020-03-05","2020-03-05","2021-06-29","2021-09-14","2020-03-05","2020-03-05","2020-03-05","2020-03-05","2020-03-05","2020-10-30","2020-01-16","2020-01-16","2021-11-17","2020-01-17","2020-01-24","2021-09-14","2020-11-02","2020-11-02","2021-01-06","2020-01-07","2020-01-12","2020-01-12","2020-11-09","2020-01-24","2020-02-11","2021-07-13","2021-09-16","2020-01-12","2020-01-12","2020-01-12","2020-12-01","2020-09-11","2020-11-02","2020-12-01","2020-12-01","2020-12-01","2020-12-01","2020-12-01","2020-01-26","2020-02-24","2020-09-12","2021-06-29","2021-08-05","2021-09-16","2021-07-30","2021-11-17","2021-11-17","2021-11-17"],"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":[["","65862050320","AMOX\/K","875-125","20","Select","Select",""],["","50111033401","METRONIDAZOL","500MG","14","Select","Select",""],["","70377002811","ATORVASTATIN","20MG","90","Select","Select",""],["","45802048678","DOCUSATE","100MG","14","Select","Select",""],["","68382033405","TRAMADL\/APAP","37.5-325","12","Select","Select",""],["","00245531911","KLOR-CON","20MEQ ER","10","Select","Select",""],["","65862007701","CIPROFLOXACN","500MG","14","Select","Select",""],["","00378182377","LEVOTHYROXIN","137MCG","90","Select","Select",""],["","65162052110","PROMETHAZINE","25MG","30","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","61442011201","ACYCLOVIR","400MG","30","Select","Select",""],["","00254100752","ALBUTEROL","HFA","7","Select","Select",""],["","70461032003","FLUCLVX","2020-21","0","Select","Select",""],["","80777027399","MODERNA","COVID-19","0","Select","Select",""],["","49884093547","DICLOFENAC","1%","100","Select","Select",""],["","00143122701","DICYCLOMINE","20MG","20","Select","Select",""],["","59746000103","METHYLPRED","4MG","21","Select","Select",""],["","58160088552","FLUARIX","2020-21","1","Select","Select",""],["","00378182377","LEVOTHYROXIN ","137MCG","30","Select","Select",""],["","45802048678","DOCUSATE ","100MG","14","Select","Select",""],["","00245531911","KLOR-CON ","20MEQ ER","10","Select","Select",""],["","65862050320","AMOX\/K ","875-125","20","Select","Select",""],["","70377002811","ATORVASTATIN ","20MG","30","Select","Select",""],["","68382033405","TRAMADL\/APAP ","37.5-325","12","Select","Select",""],["","50111033401","METRONIDAZOL ","500MG","14","Select","Select",""],["","65862007701","CIPROFLOXACN ","500MG","14","Select","Select",""],["","65162052110","PROMETHAZINE ","25MG","30","Select","Select",""],["","59310057922","PROAIR ","","-8","Select","Select",""],["","00254100752","ALBUTEROL ","HFA","7","Select","Select",""],["","49884093547","DICLOFENAC ","1%","100","Select","Select",""],["","45802004475","ACYCLOVIR ","5%","5","Select","Select",""],["","59746000103","METHYLPRED ","4MG","21","Select","Select",""],["","58160088552","FLUARIX ","2020-21","1","Select","Select",""],["","70461032003","FLUCLVX ","2020-21","0","Select","Select",""],["","80777027399","MODERNA ","COVID-19","0","Select","Select",""],["","00143122701","DICYCLOMINE ","20MG","20","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":""}]}]}