{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KATHY   L JUMP","gend":1,"add":"908 CROWELL AVE","city":"CHESAPEAKE","state":"VA","zip":"23324-9998","dob":"1958-05-15","age":"","mstatus":"","insh":"1832428*01","cliId":"","pno":"757\/333-1969","cno":"757\/333-1969","email":"","ename":"","eno":"","pphy":"GERMSCHEID, MEGAN DO","ppno":"757\/606-1656","pcpadd":"3235 BRIDGE RD #15","pcpcity":"SUFFOLK","pcpstate":"VA","pcpzip":23435,"pcpcounty":"","pcpid":110777,"pcpname":"Family Physicians of Chesapeake","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"757\/466-1009","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/606-1657","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I50.9","K21.9","E11.9","R91.8","R06.09","I50.22","E11.8","Z87.891","Z68.24","Z01.30","Z12.2","B18.2","R19.7","Z79.82","Z28.21","F17.210","I10.","I70.0","E78.5","I42.8","E11.65","N30.00","R10.13","R25.2","G25.81","Z20.828","R04.0","H69.82","E87.1","I08.0","E10.9","Z20.822"],"date":["2021-06-03","2020-02-13","2020-12-28","2020-12-28","2020-12-28","2020-12-28","2020-12-08","2020-12-28","2020-12-08","2020-12-08","2020-12-28","2020-12-28","2020-12-08","2020-12-08","2020-12-08","2020-12-28","2021-08-27","2020-12-28","2021-08-27","2020-07-07","2020-04-02","2020-12-20","2020-04-07","2020-07-08","2020-07-08","2021-04-03","2021-05-19","2021-05-19","2021-05-14","2021-06-03","2021-08-27","2021-08-14"],"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":[["","00006027754","JANUVIA","100MG","90","Select","Select",""],["","10370074501","GLIPIZIDE","5MG","180","Select","Select",""],["","00536123441","ASPIRIN","81MG EC","30","Select","Select",""],["","68180098003","LISINOPRIL","10MG","90","Select","Select",""],["","00378054101","CIMETIDINE","800MG","90","Select","Select",""],["","68382009201","CARVEDILOL","3.125MG","60","Select","Select",""],["","68645049154","PANTOPRAZOLE","40MG","90","Select","Select",""],["","68645030059","METFORMIN","1000MG","180","Select","Select",""],["","00024576105","SOLIQUA","100\/33","45","Select","Select",""],["","00173068220","VENTOLIN","","18","Select","Select",""],["","75834002001","VITAMIN","50000UNT","-4","Select","Select",""],["","00536100901","FERROUS","325MG","45","Select","Select",""],["","66993001968","ALBUTEROL","HFA","18","Select","Select",""],["","70377002911","ATORVASTATIN","40MG","90","Select","Select",""],["","35046001130","B-12","1000MCG","30","Select","Select",""],["","13811071910","NITROFURANTN","100MG","10","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","00006027754","JANUVIA ","100MG","90","Select","Select",""],["","68645049154","PANTOPRAZOLE ","40MG","90","Select","Select",""],["","68180098003","LISINOPRIL ","10MG","90","Select","Select",""],["","10370074501","GLIPIZIDE ","5MG","180","Select","Select",""],["","00378054101","CIMETIDINE ","800MG","-90","Select","Select",""],["","68382009201","CARVEDILOL ","3.125MG","60","Select","Select",""],["","00024576105","SOLIQUA ","100\/33","15","Select","Select",""],["","00536123441","ASPIRIN ","81MG EC","30","Select","Select",""],["","70377002911","ATORVASTATIN ","40MG","90","Select","Select",""],["","68645030059","METFORMIN ","1000MG","180","Select","Select",""],["","66993001968","ALBUTEROL ","HFA","18","Select","Select",""],["","00173068220","VENTOLIN ","","18","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","13811071910","NITROFURANTN ","100MG","10","Select","Select",""],["","75834002012","VITAMIN ","50000UNT","12","Select","Select",""],["","35046001130","B-12 ","1000MCG","30","Select","Select",""],["","00536100901","FERROUS ","325MG","45","Select","Select",""],["","00002771227","HUMALOG ","200\/ML","-6","Select","Select",""],["","00088221905","LANTUS ","100\/ML","-12","Select","Select",""],["","08214059080","PEN  NEEDLES  ","31GX1\/4\"","-100","Select","Select",""],["","57599080000","FREESTY ","2 SENSOR","2","Select","Select",""],["","00088221905","LANTUS","100\/ML","12","Select","Select",""],["","00002771227","HUMALOG","200\/ML","6","Select","Select",""],["","08214059080","PEN NEEDLES","31GX1\/4\"","100","Select","Select",""],["","57599080000","FREESTY","2 SENSOR","2","Select","Select",""],["","62088000033","INPEN ","MIS PINK","1","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":""}]}]}