{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"RACHEL SALMON","gend":1,"add":"3032 S FREEMAN DR","city":"WILLIAMSBURG","state":"VA","zip":"23185-9998","dob":"1983-04-25","age":"","mstatus":"","insh":"1862420*01","cliId":"","pno":"757\/784-2110","cno":"757\/784-2110","email":"","ename":"","eno":"","pphy":"MUENCH, DANIEL M MD","ppno":"757\/345-2555","pcpadd":"120 KINGS WAY SUITE 1400","pcpcity":"WILLIAMSBURG","pcpstate":"VA","pcpzip":23185,"pcpcounty":"","pcpid":118380,"pcpname":"Riverside Williamsburg Family Medicine","plan":"OHP","program":"ACA","lob":"Individual","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/345-0366","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R10.84","R50.82","K50.10","E11.9","Z96.41","Z87.891","Z98.890","Z88.8","R09.3","E10.65","I81.","K50.118","Z79.01","Z79.899","Z01.812","E10.9","Z79.4","E55.9","K50.90","Z90.49","K50.911","T38.0X5A","E09.65","R74.8","K62.89","K63.89","Z97.5","K83.8","K60.3","K50.111","M19.90","E61.1","K50.80","R10.9","K50.018","Z01.818","K50.812","T38.0X5D","K42.9","N30.00","K50.919","R73.9","E86.0","K50.112","K35.80","K21.9","F32.9","M54.5","M25.559","K43.9","N83.202","U07.1","L30.9","L85.8","L81.4","D22.9","Z12.83","Z71.9","K56.699","F41.9","J45.909","Z91.048","K56.50","L52.","K37.","Z87.19","K59.00","K64.4","Z79.3","Z79.52","K51.90","R93.5","D68.59","R53.83","K61.1","N82.3","Z20.828","Z83.3","F41.1","K52.3","Z53.8","Z51.81","Z87.42","Z86.718","E11.65","Z91.09","R53.81","E87.1","E87.2","K50.119","R19.7","R93.3","R11.2","K56.609","N83.8","R07.9","K62.4","K56.690","Z82.49","D53.9","Z20.822","M54.9","M25.512","M25.511","R82.90","K50.918"],"date":["2021-08-13","2020-01-31","2021-08-13","2021-08-09","2021-08-09","2021-08-09","2020-02-14","2021-08-09","2020-01-31","2021-09-30","2021-03-31","2021-04-14","2021-08-09","2021-08-09","2021-05-11","2021-09-30","2021-09-30","2020-07-30","2021-10-05","2021-08-09","2020-10-09","2021-08-13","2020-11-05","2021-07-30","2020-12-28","2021-08-09","2021-03-13","2020-10-09","2020-10-14","2020-10-14","2020-10-14","2021-08-09","2021-07-31","2021-08-13","2021-03-30","2020-01-24","2021-08-09","2020-11-05","2021-03-13","2021-03-13","2021-05-02","2021-05-02","2021-08-13","2021-08-13","2020-01-28","2020-01-28","2021-08-13","2020-02-14","2020-02-14","2021-03-13","2020-10-20","2020-11-30","2021-03-30","2021-03-30","2021-03-30","2021-03-30","2021-03-30","2021-03-30","2020-01-28","2021-08-13","2020-01-28","2021-03-13","2020-01-28","2020-10-11","2020-01-28","2021-07-31","2020-12-28","2021-05-12","2020-12-28","2021-07-16","2021-03-13","2021-08-13","2021-03-19","2020-06-05","2020-10-09","2020-10-09","2020-10-09","2020-10-09","2021-01-14","2021-05-12","2021-05-12","2020-10-11","2021-03-13","2021-08-12","2021-07-28","2021-08-09","2021-05-02","2021-08-03","2021-08-03","2021-08-13","2021-08-03","2021-08-12","2021-07-30","2021-07-31","2021-07-31","2021-07-31","2021-08-13","2021-08-13","2021-08-09","2021-07-31","2021-07-31","2021-07-31","2021-07-31","2021-07-31","2021-07-31","2021-07-28"],"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":[["","65862001230","SERTRALINE","50MG","90","Select","Select",""],["","00002751001","HUMALOG","100\/ML","20","Select","Select",""],["","57894006103","STELARA","90MG\/ML","1","Select","Select",""],["","66733077301","INSULIN","100\/ML","20","Select","Select",""],["","49281042050","FLUZONE","2020-21","0","Select","Select",""],["","00713050324","ANUCORT-HC","25MG","-28","Select","Select",""],["","65162004710","OXYCODONE","5MG","25","Select","Select",""],["","50228018005","GABAPENTIN","300MG","21","Select","Select",""],["","65162077810","BUDESONIDE","3MG DR","-90","Select","Select",""],["","65162083366","DICLOFENAC","1%","100","Select","Select",""],["","59137054004","RASUVO","25MG","4","Select","Select",""],["","69315012701","FOLIC","1000MCG","90","Select","Select",""],["","59746017306","PREDNISONE","10MG","45","Select","Select",""],["","50458057930","XARELTO","20MG","30","Select","Select",""],["","31722071390","PANTOPRAZOLE","40MG","30","Select","Select",""],["","00703367101","METHOTREXATE","50MG\/2ML","8","Select","Select",""],["","58657067601","CIPROFLOXACN","500MG","28","Select","Select",""],["","00003089421","ELIQUIS","5MG","60","Select","Select",""],["","45802086802","POLYETH","3350 NF","238","Select","Select",""],["","00002831501","HUMULIN","U-100","-20","Select","Select",""],["","29300022701","METRONIDAZOL","500MG","27","Select","Select",""],["","00193731221","CONTOUR","NEXT","100","Select","Select",""],["","64980014612","FLORANEX","","36","Select","Select",""],["","00169183411","NOVOLIN","U-100","30","Select","Select",""],["","65862001230","SERTRALINE ","50MG","30","Select","Select",""],["","00002751001","HUMALOG ","100\/ML","20","Select","Select",""],["","65162004710","OXYCODONE ","5MG","25","Select","Select",""],["","50228018005","GABAPENTIN ","300MG","21","Select","Select",""],["","57894006103","STELARA ","90MG\/ML","1","Select","Select",""],["","66733077301","INSULIN ","100\/ML","20","Select","Select",""],["","65162077810","BUDESONIDE ","3MG DR","90","Select","Select",""],["","65162083366","DICLOFENAC ","1%","100","Select","Select",""],["","00002831501","HUMULIN ","U-100","-30","Select","Select",""],["","29300022701","METRONIDAZOL ","500MG","27","Select","Select",""],["","16714065202","CIPROFLOXACN ","500MG","18","Select","Select",""],["","50458057930","XARELTO ","20MG","30","Select","Select",""],["","00003089470","ELIQUIS ","5MG","-30","Select","Select",""],["","31722071390","PANTOPRAZOLE ","40MG","30","Select","Select",""],["","00193731221","CONTOUR ","NEXT","100","Select","Select",""],["","59746017506","PREDNISONE ","20MG","60","Select","Select",""],["","00713050324","ANUCORT-HC ","25MG","-28","Select","Select",""],["","59137054004","RASUVO ","25MG","4","Select","Select",""],["","64980014612","FLORANEX ","","36","Select","Select",""],["","49281042050","FLUZONE ","2020-21","0","Select","Select",""],["","69315012701","FOLIC ","1000MCG","90","Select","Select",""],["","45802086802","POLYETH ","3350 NF","-238","Select","Select",""],["","00703367101","METHOTREXATE ","50MG\/2ML","8","Select","Select",""],["","00169183411","NOVOLIN ","U-100","30","Select","Select",""],["","08290320550","BD  PEN NEEDL","32GX5\/32","100","Select","Select",""],["","08627005303","DEXCOM ","SENSOR","3","Select","Select",""],["","08627002031","G4 ","RECEIVER","1","Select","Select",""],["","08627001601","DEXCOM","TRANSMIT","1","Select","Select",""],["","08627002031","G4","RECEIVER","1","Select","Select",""],["","08290320550","BD PEN NEEDL","32GX5\/32","100","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":""}]}]}