{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ELIZABETH SMITH","gend":1,"add":"2228 KINGS HWY","city":"SUFFOLK","state":"VA","zip":"23435-9998","dob":"1961-09-21","age":"","mstatus":"","insh":"1774705*01","cliId":"","pno":"757\/538-0014","cno":"757\/538-0014","email":"","ename":"","eno":"","pphy":"MAPANAO, VIVIAN MD","ppno":"757\/484-3472","pcpadd":"Bridge Road Family Medicine 4868 Br","pcpcity":"SUFFOLK","pcpstate":"VA","pcpzip":23435,"pcpcounty":"","pcpid":138558,"pcpname":"Bridge Road Family Medicine","plan":"OHP","program":"ACA","lob":"Individual","region":"TIDEWATER","aligned":"","ano":"757\/515-5187","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/483-7150","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J30.1","M54.16","M25.561","Z96.651","F98.8","D80.1","F31.9","I77.9","F39.","E78.00","Z72.0","E55.9","M54.9","Z20.2","Z01.419","M54.2","M50.33","M47.816","M43.22","M62.838","M54.41","R29.898","M51.34","Z88.9","J32.9","J32.0","J30.9","M43.16","Z12.31","D17.79","F34.1","M25.551","F41.1","Z01.812","Z01.810","M79.89","R94.31","Z79.899","M47.26","M48.061","M47.27","M54.5","G89.4","E78.5","Z23.","R13.10","Z00.00","M51.14","M51.15","F33.0","M15.0","K21.9","F41.9","G47.00","G62.89","K44.9","M54.6","M85.80","Z57.31","M16.0","R63.5","J32.2","H10.45","M47.895","R05.","Z20.828","M17.11","M16.11","Z20.822","M25.50","R09.81","M51.16","M46.97","M47.817","M54.14","F32.9","G43.909","Z88.5","Z88.2","Z88.8","Z88.4","Z88.1","Z91.040","M54.17","Z79.891","R14.0","Z68.29","K59.00","M43.12","D17.23","R22.41","F17.210","Z91.018","Z91.048","Z98.1","Z79.1","M48.00","M19.90","N76.0","B37.3","Z11.3","Z11.4","J32.1","J32.3","G95.9","Z37.3","M54.12","M50.20","M25.569","M25.519","N95.1","D25.9","N20.9","F17.200","E16.2","M50.30","K59.09","R10.9","M48.02","M47.11","Z98.890","Z12.11","M47.813","M43.13","M48.03","M47.892","M79.605","M51.17","M48.07","R30.0","R39.9","R31.9","Z86.19","N89.8","M25.562","L65.9","M54.10","M54.50"],"date":["2021-08-20","2021-10-06","2020-09-11","2021-05-26","2021-09-16","2020-10-12","2021-06-08","2020-10-12","2020-10-12","2021-11-11","2021-05-10","2021-11-11","2020-09-18","2020-10-12","2020-10-12","2021-06-29","2021-08-11","2021-05-10","2021-03-30","2021-05-10","2021-03-30","2021-03-30","2021-05-10","2021-05-10","2021-05-12","2021-08-20","2021-05-20","2020-09-10","2021-01-29","2021-04-19","2021-08-23","2021-04-19","2021-08-23","2021-05-24","2021-05-11","2021-05-28","2021-05-11","2021-06-08","2021-08-11","2021-08-11","2021-08-11","2020-12-07","2020-09-18","2020-09-18","2021-11-11","2020-09-18","2020-10-12","2020-10-31","2020-10-31","2020-10-08","2020-10-08","2021-08-23","2020-10-08","2021-08-23","2020-10-08","2021-08-23","2020-11-18","2020-10-08","2020-10-08","2021-04-19","2020-04-23","2021-08-20","2021-08-23","2020-11-18","2020-12-29","2020-12-29","2021-08-23","2021-04-19","2021-05-24","2021-06-08","2020-05-03","2021-08-11","2020-09-10","2020-09-17","2020-10-31","2020-10-31","2020-10-31","2021-05-26","2020-10-31","2021-05-26","2020-10-31","2021-05-26","2020-10-31","2020-10-31","2020-03-17","2021-08-05","2021-08-05","2021-08-05","2021-03-30","2021-05-26","2021-05-26","2021-05-26","2021-05-26","2021-05-26","2021-08-11","2021-05-26","2021-06-08","2021-11-11","2021-07-17","2021-09-16","2021-07-17","2021-07-17","2021-08-04","2021-08-04","2021-06-29","2021-07-17","2021-10-06","2021-08-23","2021-08-23","2021-08-23","2021-11-11","2021-08-23","2021-08-23","2021-08-23","2021-08-23","2021-08-23","2021-08-23","2021-08-05","2021-08-11","2021-08-11","2021-08-11","2021-05-23","2021-08-11","2021-08-11","2021-08-11","2021-08-11","2021-08-11","2021-08-11","2021-08-11","2021-09-16","2021-09-16","2021-09-16","2021-09-08","2021-09-08","2021-11-11","2021-11-11","2021-09-24","2021-10-28"],"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":[["","00555097402","AMPHET\/DEXTR","30MG","-60","Select","Select",""],["","68462012605","GABAPENTIN","600MG","60","Select","Select",""],["","29300012510","MELOXICAM","15MG","30","Select","Select",""],["","49502010202","EPINEPHRINE","0.3MG","-2","Select","Select",""],["","60505083305","AZELASTINE","0.10%","30","Select","Select",""],["","00228202996","ALPRAZOLAM","0.5MG","60","Select","Select",""],["","31722072690","MONTELUKAST","10MG","90","Select","Select",""],["","00781808926","AZITHROMYCIN","250MG","6","Select","Select",""],["","41167580003","NASACORT","55MCG\/AC","22","Select","Select",""],["","75834020815","TIZANIDINE","4MG","90","Select","Select",""],["","59746000103","METHYLPRED","4MG","21","Select","Select",""],["","23155014201","DOXYCYCL","100MG DR","10","Select","Select",""],["","65862090801","CELECOXIB","100MG","60","Select","Select",""],["","65862056090","PANTOPRAZOLE","40MG","90","Select","Select",""],["","65162062711","TRAMADOL","50MG","90","Select","Select",""],["","50111033402","METRONIDAZOL","500MG","14","Select","Select",""],["","68462010805","TOPIRAMATE","25MG","90","Select","Select",""],["","00781185220","AMOX\/K","875-125","20","Select","Select",""],["","64764072030","TRINTELLIX","5MG","30","Select","Select",""],["","63402030230","LATUDA","20MG","30","Select","Select",""],["","70069000701","OLOPATADINE","0.10%","5","Select","Select",""],["","37000074117","METAMUCIL","63%","660","Select","Select",""],["","00093314705","CEPHALEXIN","500MG","12","Select","Select",""],["","16729018201","HYDROCHLOROT","12.5MG","30","Select","Select",""],["","29300011101","LAMOTRIGINE","25MG","60","Select","Select",""],["","00363023820","STOOL","100MG","30","Select","Select",""],["","29300012510","MELOXICAM ","15MG","30","Select","Select",""],["","00555097402","AMPHET\/DEXTR ","30MG","60","Select","Select",""],["","68462012605","GABAPENTIN ","600MG","60","Select","Select",""],["","59746000103","METHYLPRED ","4MG","21","Select","Select",""],["","00228202996","ALPRAZOLAM ","0.5MG","60","Select","Select",""],["","00781808926","AZITHROMYCIN ","250MG","6","Select","Select",""],["","49502010202","EPINEPHRINE ","0.3MG","2","Select","Select",""],["","41167580003","NASACORT ","55MCG\/AC","22","Select","Select",""],["","60505083305","AZELASTINE ","0.10%","30","Select","Select",""],["","60505057501","OLOPATADINE ","0.10%","5","Select","Select",""],["","65862056090","PANTOPRAZOLE ","40MG","90","Select","Select",""],["","65862090801","CELECOXIB ","100MG","60","Select","Select",""],["","31722072690","MONTELUKAST ","10MG","90","Select","Select",""],["","75834020815","TIZANIDINE ","4MG","90","Select","Select",""],["","23155014201","DOXYCYCL ","100MG DR","10","Select","Select",""],["","37000074117","METAMUCIL ","63%","660","Select","Select",""],["","65162062711","TRAMADOL ","50MG","28","Select","Select",""],["","00093314705","CEPHALEXIN ","500MG","12","Select","Select",""],["","50111033402","METRONIDAZOL ","500MG","14","Select","Select",""],["","66685100100","AMOX\/K ","875-125","20","Select","Select",""],["","64764072030","TRINTELLIX ","5MG","30","Select","Select",""],["","68462010805","TOPIRAMATE ","25MG","90","Select","Select",""],["","63402030230","LATUDA ","20MG","-30","Select","Select",""],["","29300011101","LAMOTRIGINE ","25MG","60","Select","Select",""],["","16729018201","HYDROCHLOROT ","12.5MG","30","Select","Select",""],["","00363023820","STOOL ","100MG","30","Select","Select",""],["","59762371709","TRIAZOLAM ","0.125MG","-8","Select","Select",""],["","00591544210","PREDNISONE ","10MG","20","Select","Select",""],["","68462010340","FLUCONAZOLE ","150MG","1","Select","Select",""],["","64380080707","IBUPROFEN ","800MG","20","Select","Select",""],["","51862094205","DIAZEPAM ","5MG","3","Select","Select",""],["","65862072130","RABEPRAZOLE ","20MG","90","Select","Select",""],["","11917010300","WAL-ITIN ","10MG","30","Select","Select",""],["","60432026415","FLUTICASONE ","50MCG","-16","Select","Select",""],["","80777027398","MODERNA ","COVID-19","0","Select","Select",""],["","59762371709","TRIAZOLAM","0.125MG","-8","Select","Select",""],["","59651036205","IBUPROFEN","800MG","20","Select","Select",""],["","70954005920","PREDNISONE","10MG","-20","Select","Select",""],["","68462010340","FLUCONAZOLE","150MG","1","Select","Select",""],["","65862042005","SMZ\/TMP","800-160","6","Select","Select",""],["","80777027398","MODERNA","COVID-19","0","Select","Select",""],["","60505082901","FLUTICASONE","50MCG","16","Select","Select",""],["","70954008510","CHLORZOXAZON","500MG","28","Select","Select",""],["","51862094205","DIAZEPAM","5MG","3","Select","Select",""],["","65862072130","RABEPRAZOLE","20MG","90","Select","Select",""],["","11917010300","WAL-ITIN","10MG","30","Select","Select",""],["","52817033200","CYCLOBENZAPR","10MG","30","Select","Select",""],["","52817033200","CYCLOBENZAPR ","TAB 10MG","30","Select","Select",""],["","65862042005","SMZ\/TMP ","TAB 800-160","6","Select","Select",""],["","59651015301","PROGESTERONE ","CAP 200MG","-30","Select","Select",""],["","70954008510","CHLORZOXAZON ","TAB 500MG","28","Select","Select",""],["","00555088602","ESTRADIOL ","TAB 1MG","90","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":[[["Yes","Select","","","","","Select","",""],["Yes","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":""}]}]}