{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BRODY   T Y FEUERHAHN","gend":0,"add":"2525 ELON DR","city":"VIRGINIA BEACH","state":"VA","zip":"23454-9998","dob":"1992-07-04","age":"","mstatus":"","insh":"1866131*01","cliId":"","pno":"757\/270-6647","cno":"757\/270-6647","email":"","ename":"","eno":"","pphy":"PHYSICIAN, PRIMARY CARE (MISC)","ppno":"","pcpadd":"4417 CORPORATION LN","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23462,"pcpcounty":"","pcpid":799999,"pcpname":"","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"","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":["N28.9","J90.","Z85.47","C62.92","C78.02","Z01.812","Z79.899","C62.90","Z76.82","J45.909","Z94.84","N17.9","R17.","Z86.718","N17.0","D70.9","E83.9","E87.1","E87.6","I10.","I95.9","R21.","Z99.2","C80.1","I51.3","R05.","Z01.818","Z20.822","Z67.40","Z87.891","Z90.79","G62.9","M17.0","C78.00","R00.0","K56.609","K92.1","E87.0","R34.","E86.1","D64.81","T45.1X5A","R06.00","Z52.011","R50.81","A41.9","E87.2","K56.7","Z45.2","E86.9","R77.2","J18.9","C62.12","R91.8","J98.11","C78.2","R65.21","K92.81","C79.89","G47.9","D70.1","K71.9","D69.1","D61.810","R50.9","R06.6","R14.0","E87.5","R91.1","C61.","Z92.21","R19.7","Z46.82","C79.9","T45.1X5D","R11.0","R10.9","R18.8","K82.8","J18.1","M54.14","S20.20XA"],"date":["2020-05-18","2021-02-08","2021-04-09","2021-10-12","2021-10-12","2020-03-24","2020-12-21","2021-07-23","2020-04-18","2021-04-09","2021-04-09","2020-05-01","2020-05-01","2020-09-21","2020-04-29","2020-04-29","2020-04-29","2020-04-29","2020-04-29","2020-04-29","2020-04-29","2020-04-29","2020-04-29","2021-08-13","2021-04-08","2021-01-18","2021-04-08","2021-04-09","2021-04-08","2021-04-09","2021-04-08","2021-04-09","2021-04-09","2021-04-09","2020-04-13","2020-04-14","2020-04-24","2020-04-25","2020-04-25","2020-04-25","2020-09-21","2020-09-21","2020-09-21","2020-04-01","2020-04-17","2020-04-17","2020-04-17","2020-04-27","2020-04-30","2020-04-19","2020-07-17","2021-02-08","2021-03-12","2021-04-09","2021-04-09","2020-03-24","2020-04-02","2020-04-02","2020-04-02","2020-04-02","2020-04-02","2020-04-02","2020-04-02","2020-04-12","2020-04-14","2020-04-14","2020-04-14","2020-04-21","2021-07-23","2021-03-17","2021-04-09","2020-04-13","2020-04-14","2020-03-11","2020-04-12","2020-04-12","2020-04-14","2020-04-17","2020-04-17","2021-07-23","2021-08-13","2021-09-14"],"priorHcc":["","","",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":[["","00003089421","ELIQUIS","5MG","60","Select","Select",""],["","55513019001","NEULASTA","6MG\/0.6M","1","Select","Select",""],["","00781572005","POT CL MICRO","20MEQ ER","28","Select","Select",""],["","00054418425","DEXAMETHASON","4MG","30","Select","Select",""],["","59746011506","PROCHLORPER","10MG","-30","Select","Select",""],["","59310057922","PROAIR","","17","Select","Select",""],["","00093317431","ALBUTEROL","HFA","17","Select","Select",""],["","65862018830","ONDANSETRON","8MG","30","Select","Select",""],["","00173068220","VENTOLIN","","18","Select","Select",""],["","67877031901","IBUPROFEN","400MG","-28","Select","Select",""],["","00527193206","CLARITHROMYC","500MG","40","Select","Select",""],["","00406012301","HYDROCO\/APAP","5-325MG","8","Select","Select",""],["","00093310953","AMOXICILLIN","500MG","15","Select","Select",""],["","10702001801","OXYCODONE","5MG","20","Select","Select",""],["","00003089421","ELIQUIS ","5MG","60","Select","Select",""],["","59746011506","PROCHLORPER ","10MG","-30","Select","Select",""],["","00054418425","DEXAMETHASON ","4MG","-30","Select","Select",""],["","55513019001","NEULASTA ","6MG\/0.6M","1","Select","Select",""],["","65162046510","IBUPROFEN ","600MG","30","Select","Select",""],["","00406012301","HYDROCO\/APAP ","5-325MG","8","Select","Select",""],["","00093310953","AMOXICILLIN ","500MG","15","Select","Select",""],["","00781572005","POT  CL MICRO","20MEQ ER","28","Select","Select",""],["","65862018830","ONDANSETRON ","8MG","30","Select","Select",""],["","66993001968","ALBUTEROL ","HFA","18","Select","Select",""],["","00173068220","VENTOLIN ","","18","Select","Select",""],["","59310057922","PROAIR ","","-17","Select","Select",""],["","00527193206","CLARITHROMYC ","500MG","40","Select","Select",""],["","10702001801","OXYCODONE ","5MG","20","Select","Select",""],["","50228018001","GABAPENTIN ","300MG","90","Select","Select",""],["","50228018001","GABAPENTIN","300MG","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":[[["No","Select","","","","","Select","",""],["No","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":""}]}]}