{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JAMES   T SKIPPER","gend":0,"add":"1122 WILLOW AVE","city":"CHESAPEAKE","state":"VA","zip":"23325-9998","dob":"1967-01-06","age":"","mstatus":"","insh":"1757161*01","cliId":"","pno":"757\/403-4451","cno":"757\/403-4451","email":"","ename":"","eno":"","pphy":"ZELINSKAS, DAVID J DO","ppno":"757\/420-8297","pcpadd":"1016 JUSTIS STREET","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":23325,"pcpcounty":"","pcpid":163774,"pcpname":"INDIAN RIVER FAMILY PRACTICE","plan":"OHP","program":"ACA","lob":"Individual","region":"TIDEWATER","aligned":"","ano":"757\/403-4451","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":["E83.110","N64.4","R53.83","E55.9","I10.","E78.5","J44.1","M79.89","R06.02","Z20.822","R79.89","Z87.891","R07.9","E29.1","R19.7","M46.1","K57.32","E83.118","M25.511","K57.30","N28.1","M47.816","M89.8X8","R10.32","Z00.00","J42.","E78.00","G47.30","Z12.5","R06.00","Z79.891","K42.9","G89.29","E83.119","J44.9","Z79.899","W19.XXXA","M25.562","Z71.89","T48.6X6A","Z91.128","E66.9","Z68.38","Z88.1","Z88.0","Z91.048","R05.","Z20.828","M79.642","G89.4","M75.121","W19.XXXD","M54.5","N62.","K64.5","E83.19","Z12.11","F33.2","F43.23","Z01.810","Z01.812","G89.18","K66.0","J41.0","F41.9","M25.512","R52.","M76.71","N17.9","R07.89","E87.2","I21.4","I25.10","Z09.","M54.40","Z87.09","E78.2","Z86.79","Z68.41","Z82.49","Z83.3","Z82.3","Z80.1","Z80.8","Z82.61","M79.7","E66.01","Z23."],"date":["2021-03-04","2021-03-08","2021-03-04","2021-03-04","2021-10-20","2021-10-20","2021-03-15","2021-03-15","2021-03-15","2021-03-15","2021-03-15","2021-08-12","2021-08-12","2021-10-20","2020-02-20","2020-06-10","2020-08-06","2020-09-23","2021-03-31","2020-01-29","2020-01-29","2020-01-29","2020-01-29","2020-01-29","2021-10-20","2021-10-20","2021-08-11","2020-06-19","2021-10-20","2020-07-16","2021-02-23","2020-08-06","2021-08-24","2021-10-20","2021-08-11","2020-08-06","2020-12-04","2021-02-01","2021-03-15","2021-03-15","2021-03-15","2021-10-07","2021-03-15","2021-03-15","2021-03-15","2021-03-15","2021-03-15","2021-03-25","2020-12-01","2020-12-01","2021-01-08","2021-01-08","2021-08-11","2021-03-08","2020-01-15","2020-01-15","2021-05-23","2020-02-03","2020-02-03","2020-08-03","2020-08-03","2020-08-06","2020-08-06","2021-08-11","2021-10-20","2021-03-31","2021-06-18","2021-06-18","2021-08-13","2021-08-13","2021-08-12","2021-09-24","2021-10-20","2021-08-24","2021-08-24","2021-08-13","2021-09-24","2021-08-13","2021-08-11","2021-08-11","2021-08-11","2021-08-11","2021-08-11","2021-08-11","2021-08-11","2021-08-11","2021-08-11","2021-10-20"],"priorHcc":["","","","",null,null,"","","","","","","",null,"","","","","","","","","","",null,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":[["","24510010010","NUCYNTA","100MG","120","Select","Select",""],["","00591079510","DICYCLOMINE","20MG","120","Select","Select",""],["","55111028130","LEVOFLOXACIN","750MG","10","Select","Select",""],["","71093011105","GABAPENTIN","600MG","90","Select","Select",""],["","62559039120","VANCOMYCIN","250MG","56","Select","Select",""],["","16729018217","HYDROCHLOROT","12.5MG","30","Select","Select",""],["","68462043730","OLMESA","20MG","30","Select","Select",""],["","65162083366","DICLOFENAC","1%","100","Select","Select",""],["","16729000617","SIMVASTATIN","40MG","30","Select","Select",""],["","00591252005","CHLORZOXAZON","500MG","90","Select","Select",""],["","45802047264","HC","2.5-1%","60","Select","Select",""],["","69238148401","ERYTHROMYCIN","250MG BS","12","Select","Select",""],["","00173069500","ADVAIR","100\/50","60","Select","Select",""],["","66993058497","FLUTIC\/SALME","100\/50","60","Select","Select",""],["","65862018601","CLINDAMYCIN","300MG","14","Select","Select",""],["","57664037718","TRAMADOL","50MG","40","Select","Select",""],["","00173068220","VENTOLIN","","18","Select","Select",""],["","67877032105","IBUPROFEN","800MG","30","Select","Select",""],["","00172392670","DIAZEPAM","5MG","2","Select","Select",""],["","29300022705","METRONIDAZOL","500MG","30","Select","Select",""],["","65162027250","SMZ\/TMP","800-160","14","Select","Select",""],["","76329336901","NALOXONE","1MG\/ML","2","Select","Select",""],["","00487990130","ALBUTEROL","0.50%","15","Select","Select",""],["","08290305909","SAFETYGLIDE","21GX1.5\"","10","Select","Select",""],["","64980046799","TESTOST","200MG\/ML","2","Select","Select",""],["","00487980125","IPRATROPIUM","0.02%INH","62","Select","Select",""],["","45802086802","POLYETH","3350 NF","238","Select","Select",""],["","00143980305","DOXYCYCL","100MG","10","Select","Select",""],["","00173088710","TRELEGY","ELLIPTA","60","Select","Select",""],["","13107015599","PAROXETINE","20MG","30","Select","Select",""],["","00093220305","METOCLOPRAM","10MG","3","Select","Select",""],["","39822031005","NEOMYCIN","500MG","6","Select","Select",""],["","00378932032","WIXELA","100\/50","60","Select","Select",""],["","00054001820","PREDNISONE","20MG","12","Select","Select",""],["","08290309574","3ML","22GX1.5\"","10","Select","Select",""],["","59746000103","METHYLPRED","4MG","21","Select","Select",""],["","24510010010","NUCYNTA ","100MG","-120","Select","Select",""],["","45802047264","HC ","2.5-1%","60","Select","Select",""],["","68462043730","OLMESA ","20MG","30","Select","Select",""],["","00591252005","CHLORZOXAZON ","500MG","90","Select","Select",""],["","16729018217","HYDROCHLOROT ","12.5MG","30","Select","Select",""],["","16729000617","SIMVASTATIN ","40MG","30","Select","Select",""],["","00591079510","DICYCLOMINE ","20MG","120","Select","Select",""],["","29300022705","METRONIDAZOL ","500MG","30","Select","Select",""],["","65862052305","GABAPENTIN ","600MG","-90","Select","Select",""],["","55111028130","LEVOFLOXACIN ","750MG","10","Select","Select",""],["","62559039120","VANCOMYCIN ","250MG","56","Select","Select",""],["","65162083366","DICLOFENAC ","1%","100","Select","Select",""],["","76329336901","NALOXONE ","1MG\/ML","2","Select","Select",""],["","65862018601","CLINDAMYCIN ","300MG","14","Select","Select",""],["","00173068220","VENTOLIN ","","18","Select","Select",""],["","67877032105","IBUPROFEN ","800MG","30","Select","Select",""],["","69238148401","ERYTHROMYCIN ","250MG BS","12","Select","Select",""],["","57664037718","TRAMADOL ","50MG","40","Select","Select",""],["","00173069500","ADVAIR ","100\/50","60","Select","Select",""],["","45802086802","POLYETH ","3350 NF","238","Select","Select",""],["","66993058497","FLUTIC\/SALME ","100\/50","60","Select","Select",""],["","39822031005","NEOMYCIN ","500MG","6","Select","Select",""],["","00093220305","METOCLOPRAM ","10MG","3","Select","Select",""],["","65162027250","SMZ\/TMP ","800-160","14","Select","Select",""],["","00172392670","DIAZEPAM ","5MG","2","Select","Select",""],["","00378932032","WIXELA ","100\/50","60","Select","Select",""],["","00487950125","ALBUTEROL ","0.08%","75","Select","Select",""],["","00173088710","TRELEGY ","ELLIPTA","60","Select","Select",""],["","00054001820","PREDNISONE ","20MG","12","Select","Select",""],["","00143980305","DOXYCYCL ","100MG","10","Select","Select",""],["","00487980125","IPRATROPIUM ","0.02%INH","62","Select","Select",""],["","13107015599","PAROXETINE ","20MG","30","Select","Select",""],["","08290305909","SAFETYGLIDE ","21GX1.5\"","-10","Select","Select",""],["","62756001540","TESTOST ","200MG\/ML","2","Select","Select",""],["","08290309574","3ML ","22GX1.5\"","10","Select","Select",""],["","65597010330","BENICAR ","20MG","90","Select","Select",""],["","59746000103","METHYLPRED ","4MG","21","Select","Select",""],["","00186077760","BRILINTA ","90MG","-60","Select","Select",""],["","00904679480","ASPIRIN ","81MG","30","Select","Select",""],["","68382009305","CARVEDILOL ","6.25MG","60","Select","Select",""],["","65597010330","BENICAR","20MG","90","Select","Select",""],["","68382009305","CARVEDILOL","6.25MG","60","Select","Select",""],["","00186077760","BRILINTA","90MG","-60","Select","Select",""],["","00904679480","ASPIRIN","81MG","30","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":""}]}]}