{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BRUCE WETHINGTON","gend":0,"add":"117 COTTONWOOD LN","city":"CHESAPEAKE","state":"VA","zip":"23320-9998","dob":"1958-02-16","age":"","mstatus":"","insh":"1790911*01","cliId":"","pno":"757\/410-9117","cno":"757\/410-9117","email":"","ename":"","eno":"","pphy":"DEGUZMAN-BERUBE, ELEANOR MD","ppno":"757\/436-1234","pcpadd":"SUITE 100 108 KNELLS RIDGE BLVD","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":23320,"pcpcounty":"","pcpid":101400,"pcpname":"Atwood Family Medical Center","plan":"OHP","program":"ACA","lob":"Individual","region":"TIDEWATER","aligned":"","ano":"757\/328-1110","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":["H72.92","L29.9","H60.503","H90.5","Z12.11","Z20.828","J01.00","H92.02","Z23.","H60.502","R06.09","I25.118","E78.2","I73.9","I25.10","E78.5","Z79.02","Z79.82","Z79.899","Z87.891","R06.02","R06.00","S70.02XA","S39.012A","E78.00","Z86.718","M54.5","H60.501","J44.9","R94.39","M25.552"],"date":["2020-05-14","2020-05-14","2020-05-14","2020-05-14","2021-05-23","2021-03-19","2020-01-17","2020-01-17","2020-01-17","2020-04-28","2020-03-27","2020-06-11","2021-02-04","2020-06-16","2021-02-04","2020-06-16","2020-06-16","2020-06-16","2020-06-16","2020-06-16","2020-07-30","2021-02-04","2020-04-19","2020-04-19","2020-04-19","2020-04-19","2020-04-19","2020-04-28","2020-06-11","2020-06-11","2020-04-19"],"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":[["","00093227534","AMOX\/K","875-125","20","Select","Select",""],["","31722094101","HYDROCO\/APAP","5-325MG","10","Select","Select",""],["","00603533815","PREDNISONE","10MG","21","Select","Select",""],["","57237010099","METOPROL","25MG","60","Select","Select",""],["","65862039010","ONDANSETRON","4MG ODT","-12","Select","Select",""],["","65862005390","SIMVASTATIN","40MG","30","Select","Select",""],["","13668010501","ISOSORB","60MG ER","30","Select","Select",""],["","45802006436","TRIAMCINOLON","0.10%","80","Select","Select",""],["","65162046650","IBUPROFEN","800MG","10","Select","Select",""],["","33332042010","AFLURIA","2020-21","0","Select","Select",""],["","63304069301","CLINDAMYCIN","300MG","-15","Select","Select",""],["","00093117401","PENICILLN","500MG","28","Select","Select",""],["","00054485925","TRIAZOLAM","0.25MG","4","Select","Select",""],["","70010077001","METHOCARBAM","750MG","40","Select","Select",""],["","24208063562","NEO\/POLY\/HC","1% OTIC","10","Select","Select",""],["","00713063437","MOMETASONE","0.10%","45","Select","Select",""],["","80777027399","MODERNA","COVID-19","0","Select","Select",""],["","00603533815","PREDNISONE ","10MG","21","Select","Select",""],["","00093227534","AMOX\/K ","875-125","20","Select","Select",""],["","65862005390","SIMVASTATIN ","40MG","30","Select","Select",""],["","13668010401","ISOSORB ","30MG ER","30","Select","Select",""],["","31722094101","HYDROCO\/APAP ","5-325MG","10","Select","Select",""],["","57237010099","METOPROL ","25MG","60","Select","Select",""],["","70010077001","METHOCARBAM ","750MG","40","Select","Select",""],["","65862039010","ONDANSETRON ","4MG ODT","12","Select","Select",""],["","24208063562","NEO\/POLY\/HC ","1% OTIC","10","Select","Select",""],["","00713063437","MOMETASONE ","0.10%","45","Select","Select",""],["","00093117401","PENICILLN ","500MG","28","Select","Select",""],["","33332042010","AFLURIA ","2020-21","0","Select","Select",""],["","65862018601","CLINDAMYCIN ","300MG","-15","Select","Select",""],["","00054485925","TRIAZOLAM ","0.25MG","4","Select","Select",""],["","45802006436","TRIAMCINOLON ","0.10%","80","Select","Select",""],["","65162046650","IBUPROFEN ","800MG","10","Select","Select",""],["","80777027399","MODERNA ","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":""}]}]}