{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JUSTINE   D ERICKSEN","gend":1,"add":"706 OAK HURST CT","city":"VIRGINIA BEACH","state":"VA","zip":"23462-9998","dob":"1988-10-28","age":"","mstatus":"","insh":"1802325*01","cliId":"","pno":"757\/202-6066","cno":"757\/202-6066","email":"","ename":"","eno":"","pphy":"AMABILE, ANTHONY T MD","ppno":"757\/464-2013","pcpadd":"816 INDEPENDENCE #G","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23455,"pcpcounty":"","pcpid":100628,"pcpname":"Bayside\/Amabile","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"757\/606-1245","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":["J10.1","J45.901","F17.210","R50.9","N92.6","R30.0","F33.1","F41.0","F41.1","F32.9","A08.4","L30.9","M79.674","M79.675","B35.1","L60.0","E66.9","Z13.1","Z13.21","Z13.220","R53.1","R11.0","R53.83","Z03.818","Z20.828","E66.09","F33.40","F51.01","Z83.42","Z68.38","F34.1","R19.7","E11.9","J20.9","B37.3","E78.5","J06.9","Z00.00"],"date":["2020-02-25","2020-02-25","2020-02-25","2020-02-25","2021-09-08","2020-06-04","2020-10-05","2020-10-05","2020-10-05","2021-10-11","2021-06-02","2021-06-02","2020-08-26","2020-08-26","2020-08-26","2020-08-26","2020-06-18","2020-06-18","2020-06-18","2020-06-18","2020-08-20","2020-08-20","2020-08-20","2020-08-20","2020-08-20","2020-08-13","2021-09-08","2020-04-20","2020-04-20","2020-08-13","2020-12-14","2021-09-08","2020-08-26","2020-02-12","2020-08-13","2020-08-13","2021-07-20","2021-09-08"],"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":[["","64380071306","BENZONATATE","200MG","-40","Select","Select",""],["","00254100752","ALBUTEROL","HFA","7","Select","Select",""],["","69238126601","OSELTAMIVIR","75MG","10","Select","Select",""],["","69543025216","VIRTUSSIN","100-10\/5","120","Select","Select",""],["","69097084805","ESCITALOPRAM","10MG","30","Select","Select",""],["","13668033005","TRAZODONE","50MG","-30","Select","Select",""],["","59746000103","METHYLPRED","4MG","21","Select","Select",""],["","68462010530","ONDANSETRON","4MG","20","Select","Select",""],["","00713075937","BETAMETH","0.05%","45","Select","Select",""],["","29300011201","LAMOTRIGINE","100MG","30","Select","Select",""],["","10702002501","PHENTERMINE","37.5MG","30","Select","Select",""],["","00228202796","ALPRAZOLAM","0.25MG","20","Select","Select",""],["","64764073030","TRINTELLIX","10MG","30","Select","Select",""],["","68462029855","CLOTRIM\/BETA","DIPROP","-45","Select","Select",""],["","57237000511","FLUCONAZOLE","150MG","2","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","80777027310","MODERNA","COVID-19","0","Select","Select",""],["","00591544305","PREDNISONE","20MG","30","Select","Select",""],["","69452015120","VITAMIN","50000UNT","12","Select","Select",""],["","00378718505","METFORMIN","500MG","30","Select","Select",""],["","00591042405","TRIAMT\/HCTZ","37.5-25","30","Select","Select",""],["","65862052890","VENLAFAXINE","75MG ER","30","Select","Select",""],["","59746000103","METHYLPRED ","4MG","21","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","00254100752","ALBUTEROL ","HFA","7","Select","Select",""],["","64380071306","BENZONATATE ","200MG","30","Select","Select",""],["","69543025216","VIRTUSSIN ","100-10\/5","120","Select","Select",""],["","68462010530","ONDANSETRON ","4MG","20","Select","Select",""],["","69238126601","OSELTAMIVIR ","75MG","10","Select","Select",""],["","13668033005","TRAZODONE ","50MG","-30","Select","Select",""],["","00228202796","ALPRAZOLAM ","0.25MG","20","Select","Select",""],["","69097084805","ESCITALOPRAM ","10MG","30","Select","Select",""],["","00591544305","PREDNISONE ","20MG","30","Select","Select",""],["","00591042405","TRIAMT\/HCTZ ","37.5-25","30","Select","Select",""],["","00713075937","BETAMETH ","0.05%","45","Select","Select",""],["","10702002501","PHENTERMINE ","37.5MG","30","Select","Select",""],["","68462029855","CLOTRIM\/BETA ","DIPROP","-45","Select","Select",""],["","69452015120","VITAMIN ","50000UNT","12","Select","Select",""],["","00378718505","METFORMIN ","500MG","30","Select","Select",""],["","57237000511","FLUCONAZOLE ","150MG","2","Select","Select",""],["","29300011101","LAMOTRIGINE ","25MG","60","Select","Select",""],["","64764073030","TRINTELLIX ","10MG","30","Select","Select",""],["","65862052890","VENLAFAXINE ","75MG ER","30","Select","Select",""],["","80777027398","MODERNA ","COVID-19","0","Select","Select",""],["","62542030117","HYD ","10-8\/5ML","70","Select","Select",""],["","59762219807","AZITHROMYCIN ","250MG","-6","Select","Select",""],["","59762219807","AZITHROMYCIN","250MG","-6","Select","Select",""],["","27808008602","HYD","10-8\/5ML","70","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","",""],["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":""}]}]}