{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LORA HUNTER","gend":1,"add":"6425 OLD KELLY DR","city":"SUFFOLK","state":"VA","zip":"23437-9998","dob":"1960-03-02","age":"","mstatus":"","insh":"1870508*02","cliId":"","pno":"757\/633-2616","cno":"757\/633-2616","email":"","ename":"","eno":"","pphy":"","ppno":"","pcpadd":"","pcpcity":"","pcpstate":"","pcpzip":"","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"ACA","lob":"Individual","region":"TIDEWATER","aligned":"","ano":"757\/657-2112","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":["R60.9","C50.411","Z17.0","C50.911","R22.31","K59.00","K21.9","E66.3","Z80.0","C50.412","J02.9","I48.91","Z79.811","E55.9","I70.0","I10.","E66.09","Z68.33","Z12.11","R00.1","R06.02","I47.1","G64.","H43.392","R10.9","R07.9","I89.0","I16.0","Z82.49","E66.9","Z68.32","E78.5","E78.00","R73.03","G62.0","T45.1X5A","Z92.3","Z20.822","Z85.3","Z88.8","R53.83","Z12.31","N76.0","Z12.4","Z01.419","R60.0","J30.89","E78.2","I48.0","Z90.710","Z86.010","R13.10","I49.9","Z12.39"],"date":["2020-04-21","2021-07-14","2021-07-14","2021-06-29","2020-06-22","2021-11-12","2021-07-14","2020-10-05","2020-12-07","2021-06-29","2021-07-23","2021-07-23","2021-06-29","2021-06-29","2021-07-14","2021-07-16","2021-07-16","2021-07-16","2021-05-23","2021-07-15","2021-07-15","2021-08-24","2021-06-29","2021-09-09","2020-03-08","2021-07-14","2020-05-05","2021-07-14","2021-07-14","2021-07-14","2021-07-14","2021-07-14","2021-07-16","2021-07-14","2021-07-14","2021-07-14","2021-07-14","2021-07-14","2020-03-08","2020-03-08","2020-06-15","2021-11-01","2020-12-10","2020-12-10","2020-12-10","2021-05-05","2021-05-05","2021-05-05","2021-08-16","2020-06-22","2021-11-12","2021-11-12","2021-11-12","2021-11-01"],"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":[["","65862039010","ONDANSETRON","4MG ODT","3","Select","Select",""],["","60505258009","ATORVASTATIN","40MG","60","Select","Select",""],["","52268001201","SUPREP","PREP KIT","354","Select","Select",""],["","27808015801","ROSUVASTATIN","40MG","90","Select","Select",""],["","16729018201","HYDROCHLOROT","12.5MG","180","Select","Select",""],["","75834002012","VITAMIN","50000UNT","12","Select","Select",""],["","58487001982","VIT","","30","Select","Select",""],["","59651018030","LETROZOLE","2.5MG","30","Select","Select",""],["","00456120130","LINZESS","145MCG","30","Select","Select",""],["","45802013970","METRONIDAZOL","0.75%VAG","-70","Select","Select",""],["","00054429731","FUROSEMIDE","20MG","30","Select","Select",""],["","50458057990","XARELTO","20MG","30","Select","Select",""],["","00003089421","ELIQUIS","5MG","-60","Select","Select",""],["","53746064101","FLECAINIDE","50MG","60","Select","Select",""],["","52817036000","METOPROL","25MG","30","Select","Select",""],["","16714049401","AMOX\/K","500-125","30","Select","Select",""],["","65862039010","ONDANSETRON ","TAB 4MG ODT","3","Select","Select",""],["","16729018201","HYDROCHLOROT ","TAB 12.5MG","180","Select","Select",""],["","60505258009","ATORVASTATIN ","TAB 40MG","60","Select","Select",""],["","52268001201","SUPREP ","SOL PREP KIT","354","Select","Select",""],["","27808015801","ROSUVASTATIN ","TAB 40MG","90","Select","Select",""],["","75834002012","VITAMIN ","CAP 50000UNT","12","Select","Select",""],["","58487001982","VIT ","TAB ","30","Select","Select",""],["","59651018030","LETROZOLE ","TAB 2.5MG","30","Select","Select",""],["","00456120130","LINZESS ","CAP 145MCG","30","Select","Select",""],["","45802013970","METRONIDAZOL ","GEL 0.75%VAG","-70","Select","Select",""],["","00054429731","FUROSEMIDE ","TAB 20MG","30","Select","Select",""],["","50458057990","XARELTO ","TAB 20MG","30","Select","Select",""],["","00003089421","ELIQUIS ","TAB 5MG","-60","Select","Select",""],["","53746064101","FLECAINIDE ","TAB 50MG","60","Select","Select",""],["","65862006299","METOPROL ","TAB 25MG","45","Select","Select",""],["","16714049401","AMOX\/K ","TAB 500-125","30","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","",""],["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":""}]}]}