{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SHARON   K WHITFIELD","gend":1,"add":"3013 ARMENTROUT CT","city":"CHESAPEAKE","state":"VA","zip":"23324-9998","dob":"1966-02-24","age":"","mstatus":"","insh":"1818225*02","cliId":"","pno":"757\/405-2803","cno":"757\/405-2803","email":"","ename":"","eno":"","pphy":"SKEES, MARK E MD","ppno":"757\/623-8642","pcpadd":"STE 201 400 W BRAMBLETON AVE","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23510,"pcpcounty":"","pcpid":141386,"pcpname":"Skees Family Practice","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"757\/405-2803","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":["M54.5","R11.2","R07.9","E66.01","Z98.890","Z96.651","G89.29","R42.","E53.8","R53.83","G43.009","M25.561","M62.838","M54.41","M51.16","Z98.84","M43.16","E55.9","Z00.00","Z48.89","J45.41","I10.","E78.5","D50.8","K21.9","M47.26","Z98.1","F32.4","M25.511","S79.911A","S92.504D","M54.2","M79.89","R50.9","R10.32","M25.551","M16.11","M16.12","Z68.31","D50.9","D49.2","M89.9","G43.909","G47.33","G56.00","M47.816","J40.","J45.20","K21.00","Z68.29","Z88.5","Z88.6","Z91.013","Z88.7","Z88.8","Z91.09","R25.2","M54.12","M50.90","Z09.","T50.905A","Z01.812","Z20.822","Z01.818","M48.02","D64.9","R50.82","R94.31","I45.10","I51.7","Z20.828","M25.461","R00.0","Z88.3","S19.9XXA","Z47.1","M54.16","M47.815","M10.061","F32.9","F41.0","N28.1","R10.9","Z90.49","N17.9","E11.8","Z79.4","N39.0","T83.098A","A41.9","J96.11","J45.909","Z79.01","Z79.899","Z68.30","M48.061","M43.17","M48.07","D25.1","R10.2","K56.2","K46.0","R10.13","S89.91XA","R10.30","E87.6","G43.109","K13.0","B37.0","M25.531","G56.01","M50.30","T78.2XXA","R21.","J20.9","J41.1","R10.12","R11.0","Z91.048","D53.9","F41.9","G89.18","M17.11","R06.02","W19.XXXA","S46.812A","M43.22","M54.42","Z46.82","R10.31","I49.9","M50.323","M79.651","M54.9","Z87.442","Z68.35","Z82.49","M50.123","M47.22","S92.504A","S92.514D","Z01.810","M10.9","M79.604","I82.409","M25.552","R05.","D25.9","K45.8","K86.89","Z80.0","B37.3","Z11.1","S92.514A","G89.4","Z12.31","M13.0","M79.10","M96.1","G58.9","M62.50","M79.2","F11.20","R13.10","M79.7","E04.1","R51.9","M79.601","M50.10","M54.02"],"date":["2021-01-28","2020-12-27","2020-05-14","2021-03-03","2021-02-15","2021-10-10","2021-03-03","2020-07-21","2020-07-10","2020-10-09","2021-10-10","2020-11-06","2021-08-19","2020-09-30","2020-10-20","2021-10-10","2020-11-27","2020-12-18","2020-12-18","2020-10-23","2021-01-25","2021-10-10","2020-12-18","2020-12-21","2021-10-10","2020-12-07","2021-10-06","2020-12-07","2021-03-03","2021-04-28","2021-04-28","2021-07-20","2021-05-20","2021-05-20","2020-05-14","2020-08-13","2020-08-13","2020-10-14","2020-10-20","2020-10-20","2020-10-20","2020-10-20","2020-10-20","2021-03-03","2020-10-20","2020-10-20","2020-10-20","2021-05-18","2020-10-20","2020-10-25","2021-10-10","2021-10-10","2021-10-10","2021-10-10","2021-10-10","2020-10-25","2021-08-12","2021-10-10","2021-03-16","2021-01-07","2021-01-07","2021-05-15","2021-05-15","2021-05-15","2021-10-06","2021-05-19","2021-05-19","2021-05-05","2020-05-05","2020-05-05","2020-10-17","2021-02-09","2020-05-31","2021-03-03","2020-05-31","2020-11-06","2020-06-01","2020-06-01","2020-06-01","2021-05-18","2020-06-01","2020-11-27","2020-11-23","2021-02-13","2020-05-12","2020-05-12","2020-05-12","2020-05-12","2020-05-12","2020-05-12","2020-05-12","2021-10-10","2020-05-14","2021-10-10","2021-03-03","2020-10-20","2020-11-27","2020-10-20","2020-12-23","2020-12-23","2020-12-27","2020-12-27","2020-12-27","2021-02-09","2021-02-15","2021-02-15","2021-03-02","2021-03-31","2021-03-31","2021-04-16","2021-04-16","2021-05-03","2020-09-19","2020-09-19","2020-11-02","2020-11-02","2020-11-23","2021-10-10","2021-10-10","2020-05-05","2020-11-23","2020-05-08","2020-06-19","2020-05-14","2020-06-05","2020-09-01","2021-07-20","2020-09-30","2021-01-01","2021-01-19","2021-05-18","2020-05-31","2020-08-25","2020-11-23","2021-02-13","2020-11-23","2021-02-13","2021-03-23","2021-10-06","2021-04-28","2021-04-28","2021-05-05","2020-05-07","2020-05-08","2020-05-31","2020-10-14","2020-10-14","2020-11-27","2020-11-27","2020-11-27","2020-11-27","2021-04-12","2021-07-20","2021-04-13","2021-08-19","2021-08-11","2021-09-02","2021-09-02","2021-09-21","2021-09-21","2021-09-21","2021-09-21","2021-09-21","2021-09-02","2021-09-02","2021-10-06","2021-10-10","2021-10-03","2021-10-06","2021-10-06"],"priorHcc":["","","","","",null,"","","","",null,"","","","",null,"","","","","",null,"","",null,"",null,"","","","","","","","","","","","","","","","","","","","","","","",null,null,null,null,null,"","",null,"","","","","","",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":[["","53746010901","HYDROCO\/APAP","5-325MG","25","Select","Select",""],["","00527133001","BACLOFEN","10MG","20","Select","Select",""],["","50458058030","XARELTO","10MG","12","Select","Select",""],["","10702001801","OXYCODONE","5MG","60","Select","Select",""],["","00591544305","PREDNISONE","20MG","18","Select","Select",""],["","68462010530","ONDANSETRON","4MG","20","Select","Select",""],["","69547035302","NARCAN","","-2","Select","Select",""],["","80681002500","VITAMIN","100MG","-30","Select","Select",""],["","65162062711","TRAMADOL","50MG","25","Select","Select",""],["","65862020299","LOSARTAN","50MG","30","Select","Select",""],["","66993001968","ALBUTEROL","HFA","18","Select","Select",""],["","52817033200","CYCLOBENZAPR","10MG","60","Select","Select",""],["","59746000103","METHYLPRED","4MG","21","Select","Select",""],["","59746012106","MECLIZINE","25MG","30","Select","Select",""],["","50111064801","FLUOXETINE","20MG","60","Select","Select",""],["","00245531811","KLOR-CON","15MEQ ER","180","Select","Select",""],["","69584061210","METHOCARBAM","750MG","42","Select","Select",""],["","27808008601","HYD","10-8\/5ML","-120","Select","Select",""],["","00115174801","METAXALONE","800MG","-60","Select","Select",""],["","29300012810","HYDROCHLOROT","25MG","90","Select","Select",""],["","00591079501","DICYCLOMINE","20MG","40","Select","Select",""],["","57664050658","METOPROL","25MG","90","Select","Select",""],["","00406048410","APAP\/CODEINE","300-30MG","25","Select","Select",""],["","49502010202","EPINEPHRINE","0.3MG","2","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","00378932132","WIXELA","250\/50","60","Select","Select",""],["","65162010250","GABAPENTIN","300MG","90","Select","Select",""],["","00527169505","BUT\/APAP\/CAF","","25","Select","Select",""],["","65862007701","CIPROFLOXACN","500MG","-14","Select","Select",""],["","00472037945","CLOTRIM\/BETA","DIPROP","-45","Select","Select",""],["","00173068220","VENTOLIN","","18","Select","Select",""],["","00406324301","HYDROMORPHON","2MG","30","Select","Select",""],["","00536100901","FERROUS","325MG","30","Select","Select",""],["","00173069600","ADVAIR","250\/50","60","Select","Select",""],["","57237000511","FLUCONAZOLE","150MG","2","Select","Select",""],["","35046001130","B-12","1000MCG","30","Select","Select",""],["","45802048678","DOCUSATE","100MG","30","Select","Select",""],["","00904759080","FEROSUL","325MG","30","Select","Select",""],["","65862053750","LEVOFLOXACIN","500MG","10","Select","Select",""],["","63304007601","POT CHLORIDE","10MEQ ER","-60","Select","Select",""],["","00054414622","CLOTRIMAZOLE","10MG","24","Select","Select",""],["","57896020110","PAIN","500MG","60","Select","Select",""],["","65862085901","FAMOTIDINE","20MG","14","Select","Select",""],["","59762040101","SUCRALFATE","1GM","30","Select","Select",""],["","53746010901","HYDROCO\/APAP ","5-325MG","25","Select","Select",""],["","52817033200","CYCLOBENZAPR ","10MG","30","Select","Select",""],["","00591544305","PREDNISONE ","20MG","18","Select","Select",""],["","00527133001","BACLOFEN ","10MG","-20","Select","Select",""],["","50458058030","XARELTO ","10MG","-20","Select","Select",""],["","10702001801","OXYCODONE ","5MG","60","Select","Select",""],["","45802048678","DOCUSATE ","100MG","30","Select","Select",""],["","65862018730","ONDANSETRON ","4MG","-20","Select","Select",""],["","70010075401","METHOCARBAM ","500MG","30","Select","Select",""],["","00406048410","APAP\/CODEINE ","300-30MG","14","Select","Select",""],["","57664050658","METOPROL ","25MG","30","Select","Select",""],["","69547035302","NARCAN ","","-2","Select","Select",""],["","69452015120","VITAMIN ","50000UNT","-12","Select","Select",""],["","00245531811","KLOR-CON ","15MEQ ER","180","Select","Select",""],["","29300012810","HYDROCHLOROT ","25MG","90","Select","Select",""],["","59746012106","MECLIZINE ","25MG","30","Select","Select",""],["","59746000103","METHYLPRED ","4MG","21","Select","Select",""],["","65162062711","TRAMADOL ","50MG","25","Select","Select",""],["","00173068220","VENTOLIN ","","18","Select","Select",""],["","66993001968","ALBUTEROL ","HFA","18","Select","Select",""],["","65862020299","LOSARTAN ","50MG","30","Select","Select",""],["","50111064801","FLUOXETINE ","20MG","60","Select","Select",""],["","49502010202","EPINEPHRINE ","0.3MG","2","Select","Select",""],["","62542030117","HYD ","10-8\/5ML","120","Select","Select",""],["","00406324301","HYDROMORPHON ","2MG","42","Select","Select",""],["","57896020110","PAIN ","500MG","60","Select","Select",""],["","00527143501","METAXALONE ","800MG","30","Select","Select",""],["","65862085901","FAMOTIDINE ","20MG","14","Select","Select",""],["","59310057922","PROAIR ","","-8","Select","Select",""],["","00904759080","FEROSUL ","325MG","30","Select","Select",""],["","11917009215","FERROUS ","325MG","30","Select","Select",""],["","59762040101","SUCRALFATE ","1GM","30","Select","Select",""],["","00173069600","ADVAIR ","250\/50","60","Select","Select",""],["","00591079501","DICYCLOMINE ","20MG","40","Select","Select",""],["","65862007701","CIPROFLOXACN ","500MG","14","Select","Select",""],["","63304007601","POT  CHLORIDE","10MEQ ER","-60","Select","Select",""],["","00527169505","BUT\/APAP\/CAF ","","25","Select","Select",""],["","00472037945","CLOTRIM\/BETA ","DIPROP","45","Select","Select",""],["","00054414622","CLOTRIMAZOLE ","10MG","24","Select","Select",""],["","57237000430","FLUCONAZOLE ","100MG","9","Select","Select",""],["","35046001130","B-12 ","1000MCG","30","Select","Select",""],["","65862053750","LEVOFLOXACIN ","500MG","10","Select","Select",""],["","65162010250","GABAPENTIN ","300MG","90","Select","Select",""],["","00378932132","WIXELA ","250\/50","60","Select","Select",""],["","59651031577","TIZANIDINE ","4MG","18","Select","Select",""],["","59651031577","TIZANIDINE","4MG","18","Select","Select",""],["","65162074510","PROMETHAZINE","12.5MG","20","Select","Select",""],["","67877026118","RIZATRIPTAN","5MG","20","Select","Select",""],["","65862050320","AMOX\/K","875-125","20","Select","Select",""],["","65162074510","PROMETHAZINE ","TAB 12.5MG","20","Select","Select",""],["","00093031101","LOPERAMIDE ","CAP 2MG","12","Select","Select",""],["","67877026118","RIZATRIPTAN ","TAB 5MG","20","Select","Select",""],["","65862050320","AMOX\/K ","TAB 875-125","20","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":""}]}]}