{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DOMINIQUE   LYNN TAYLOR","gend":1,"add":"1200 FONTANA AVE","city":"CHESAPEAKE","state":"VA","zip":"23325-9998","dob":"1968-09-12","age":"","mstatus":"","insh":"1860221*01","cliId":"","pno":"757\/724-1050","cno":"757\/724-1050","email":"","ename":"","eno":"","pphy":"ZELINSKAS, DAVID J DO","ppno":"757\/420-8297","pcpadd":"1016 JUSTIS STREET","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":23325,"pcpcounty":"","pcpid":163774,"pcpname":"INDIAN RIVER FAMILY PRACTICE","plan":"OHP","program":"ACA","lob":"Individual","region":"TIDEWATER","aligned":"","ano":"757\/724-1050","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/523-5639","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I10.","E78.5","E11.65","E78.2","F33.9","E66.9","M77.12","M54.5","Z12.11","M65.331","Z68.32","M21.70","Z98.890","M54.12","Z68.31","R52.","Z03.818","R11.2","M48.02","E11.9","M47.892","M79.10","M99.03","M99.05","M99.04","M47.12","M54.2","Z12.13","F14.20","F12.20","F10.10","F39."],"date":["2021-07-14","2021-07-14","2021-07-14","2021-04-02","2020-12-08","2020-12-08","2020-12-08","2020-12-08","2021-05-23","2020-10-28","2020-12-04","2020-12-17","2020-12-17","2021-06-26","2020-07-06","2020-06-22","2020-06-22","2020-06-22","2021-06-26","2020-02-04","2021-06-26","2020-12-04","2020-12-04","2020-12-04","2020-12-04","2021-08-09","2021-10-07","2021-11-23","2021-10-22","2021-10-22","2021-10-22","2021-10-22"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","",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":[["","00006008061","JANUMET ","50-1000","90","Select","Select",""],["","68462018905","NAPROXEN ","375MG","30","Select","Select",""],["","51991075033","DULOXETINE ","40MG","30","Select","Select",""],["","55111012405","ATORVASTATIN ","80MG","90","Select","Select",""],["","55111032201","GLIMEPIRIDE ","4MG","60","Select","Select",""],["","27241011703","FENOFIBRATE ","160MG","30","Select","Select",""],["","55111046701","METOPROL ","50MG ER","-90","Select","Select",""],["","45963067611","METOPROLOL ","50MG ER","90","Select","Select",""],["","75987004005","PENNSAID ","2%","112","Select","Select",""],["","57237007710","ONDANSETRON ","4MG ODT","30","Select","Select",""],["","52817033200","CYCLOBENZAPR ","10MG","45","Select","Select",""],["","00363237001","LANCET ","THIN 30G","-100","Select","Select",""],["","08271036100","LANCETS ","THIN","-100","Select","Select",""],["","56151195002","TRUE ","METER","1","Select","Select",""],["","53489012002","DOXYCYCL ","100MG","14","Select","Select",""],["","00006008061","JANUMET","50-1000","-15","Select","Select",""],["","55111032201","GLIMEPIRIDE","4MG","60","Select","Select",""],["","51991075033","DULOXETINE","40MG","-30","Select","Select",""],["","42858066045","FENOFIBRATE","160MG","30","Select","Select",""],["","68462018905","NAPROXEN","375MG","90","Select","Select",""],["","55111012405","ATORVASTATIN","80MG","90","Select","Select",""],["","45963067611","METOPROLOL","50MG ER","-90","Select","Select",""],["","55111046701","METOPROL","50MG ER","90","Select","Select",""],["","57237007710","ONDANSETRON","4MG ODT","-30","Select","Select",""],["","75987004005","PENNSAID","2%","112","Select","Select",""],["","52817033200","CYCLOBENZAPR","10MG","45","Select","Select",""],["","00363237001","LANCET","THIN 30G","-100","Select","Select",""],["","08271036100","LANCETS","THIN","100","Select","Select",""],["","56151146004","TRUE","GLUCOSE","150","Select","Select",""],["","53489012002","DOXYCYCL","100MG","14","Select","Select",""],["","65862020299","LOSARTAN ","TAB 50MG","-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":""}]}]}