{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SARAH   A SHRADER","gend":1,"add":"441 BLANCHE DR S","city":"CHESAPEAKE","state":"VA","zip":"23323-9998","dob":"1990-10-30","age":"","mstatus":"","insh":"1769809*02","cliId":"","pno":"757\/619-6275","cno":"757\/619-6275","email":"","ename":"","eno":"","pphy":"PICCIONI, FRANK J DO","ppno":"757\/495-0606","pcpadd":"STE 103 516 INNOVATION DR","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":23320,"pcpcounty":"","pcpid":131473,"pcpname":"","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"703\/232-2263, ","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/842-6605","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F31.12","F33.41","Z33.1","F33.2","F31.81","Z34.90","Z87.59","Z12.4","Z36.9","F32.2","D50.8","D50.9","K91.2","Z90.3","E66.9","Z68.31","Z68.32","O99.891","R10.11","R11.0","O99.012","D64.9","O09.42","Z3A.26","Z98.84","Z88.8","Z79.899","Z90.49","Z87.42","Z68.33","E61.1","E55.9","J02.9","Z11.59","Z30.017","Z34.91","Z34.83","Z3A.28","Z23.","Z30.46","O36.80X9","Z3A.08","O21.9","Z36.3","Z3A.20","Z36.1","O47.03","O99.013","O99.343","F31.9","F41.9","F90.9","O34.219","O09.293","O99.213","O99.843","Z3A.32","O26.893","Z36.85","R53.83","O99.283","E86.0","O34.212","Z3A.36","R19.7","O99.344","O70.0","Z37.0","Z3A.38","Z3A.34","O21.2","Z20.822","R11.2","O26.93","O26.13","Z3A.37","O34.211","D62.","F99.","F98.8","O90.81","Z71.3","Z39.2","Z32.02"],"date":["2021-08-11","2021-08-11","2020-03-19","2020-09-24","2021-02-18","2021-07-13","2021-06-10","2020-12-23","2021-05-12","2021-09-24","2021-06-16","2021-06-10","2021-08-27","2021-08-27","2021-08-27","2020-11-24","2020-10-23","2021-04-09","2021-04-09","2021-04-09","2021-04-09","2021-06-20","2021-04-09","2021-04-09","2021-07-06","2021-07-17","2021-07-06","2021-04-09","2021-04-09","2021-08-27","2020-09-16","2021-08-27","2020-02-08","2020-02-08","2021-08-31","2020-12-03","2021-05-12","2021-05-12","2021-05-12","2020-10-06","2020-12-22","2020-12-22","2021-06-20","2021-03-16","2021-03-16","2021-02-16","2021-06-10","2021-07-06","2021-06-20","2021-07-17","2021-06-10","2021-06-20","2021-07-18","2021-06-10","2021-07-06","2021-06-20","2021-06-10","2021-06-10","2021-07-02","2021-06-25","2021-07-06","2021-07-06","2021-07-06","2021-07-06","2021-07-06","2021-07-18","2021-07-18","2021-07-18","2021-07-18","2021-06-20","2021-06-20","2021-07-17","2021-06-20","2021-07-06","2021-07-13","2021-07-13","2021-07-17","2021-07-17","2021-07-17","2021-07-17","2021-07-17","2021-08-27","2021-08-31","2021-08-31"],"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":[["","00093310905","AMOXICILLIN","500MG","20","Select","Select",""],["","68180029706","DULOXETINE","40MG","-30","Select","Select",""],["","63402030430","LATUDA","40MG","-30","Select","Select",""],["","66993060536","ETONOGESTERE","ETHY EST","3","Select","Select",""],["","13107008305","LORAZEPAM","0.5MG","15","Select","Select",""],["","70436001006","BUPROPN","150MG XL","14","Select","Select",""],["","50111033401","METRONIDAZOL","500MG","14","Select","Select",""],["","58160088552","FLUARIX","2020-21","0","Select","Select",""],["","10702002601","PHENTERMINE","15MG","30","Select","Select",""],["","45802075930","PROMETHAZINE","25MG","20","Select","Select",""],["","69097081312","GABAPENTIN","100MG","90","Select","Select",""],["","43547030303","ARIPIPRAZOLE","5MG","14","Select","Select",""],["","57237007810","ONDANSETRON","8MG ODT","30","Select","Select",""],["","59267100002","PFIZER","COVID-19","0","Select","Select",""],["","51991070505","ALPRAZOLAM","0.5MG","30","Select","Select",""],["","00093310905","AMOXICILLIN ","500MG","-20","Select","Select",""],["","66993060536","ETONOGESTERE ","ETHY EST","3","Select","Select",""],["","13107008305","LORAZEPAM ","0.5MG","15","Select","Select",""],["","43547030303","ARIPIPRAZOLE ","5MG","14","Select","Select",""],["","68180029706","DULOXETINE ","40MG","-30","Select","Select",""],["","63402030430","LATUDA ","40MG","30","Select","Select",""],["","58160088552","FLUARIX ","2020-21","0","Select","Select",""],["","70436001006","BUPROPN ","150MG XL","14","Select","Select",""],["","10702002601","PHENTERMINE ","15MG","30","Select","Select",""],["","57237007810","ONDANSETRON ","8MG ODT","30","Select","Select",""],["","50111033401","METRONIDAZOL ","500MG","14","Select","Select",""],["","69097081312","GABAPENTIN ","100MG","90","Select","Select",""],["","59267100002","PFIZER ","COVID-19","0","Select","Select",""],["","51991070505","ALPRAZOLAM ","0.5MG","30","Select","Select",""],["","45802075930","PROMETHAZINE ","25MG","20","Select","Select",""],["","42858000101","OXYCODONE ","5MG","10","Select","Select",""],["","62541020130","QSYMIA ","3.75-23","14","Select","Select",""],["","55111052130","ATOMOXETINE ","40MG","30","Select","Select",""],["","42858000101","OXYCODONE","5MG","10","Select","Select",""],["","62541020230","QSYMIA","7.5-46MG","14","Select","Select",""],["","55111056330","ATOMOXETINE","80MG","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","",""],["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":""}]}]}