{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CRISTAN KUNTZ","gend":1,"add":"1564 BRIDLE CREEK BLVD","city":"VIRGINIA BEACH","state":"VA","zip":"23464-9998","dob":"1988-09-26","age":"","mstatus":"","insh":"1879142*02","cliId":"","pno":"757\/677-6520","cno":"757\/677-6520","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":"757\/675-3751","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":["I47.2","F41.1","N92.5","Z11.3","Z01.419","Z36.9","O99.211","O02.1","Z32.02","Z32.01","Z12.39","O20.0","Z00.00","E78.5","Z20.828","R00.2","E78.2","Z32.00","Z34.81","Z3A.10","O36.80X0","Z3A.01","R93.89","Z88.0","Z3A.00","R11.0","O26.891","R10.9","K21.9","Z33.1","Z36.1","Z34.02","Z3A.20","Z36.3","Z3A.23","Z36.89","Z13.32","Z39.1","Z3A.27","Z34.82","Z34.83","O09.93","O24.419","Z71.3","Z3A.36","O99.810","O24.410","Z3A.31","Z23.","R82.90","Z3A.34","O09.90"],"date":["2020-01-27","2020-01-27","2020-05-28","2020-05-28","2021-04-28","2021-05-25","2021-05-25","2020-07-21","2020-07-21","2021-04-28","2020-05-28","2020-07-03","2020-07-27","2020-07-27","2021-02-05","2020-07-20","2021-06-23","2021-04-28","2021-05-19","2021-05-19","2020-06-15","2020-07-03","2020-07-03","2020-07-03","2020-07-03","2020-07-03","2020-07-03","2020-07-03","2021-06-23","2021-06-23","2021-07-14","2021-08-18","2021-07-29","2021-08-18","2021-08-18","2021-09-20","2021-09-20","2021-09-30","2021-09-20","2021-09-30","2021-09-30","2021-11-16","2021-11-16","2021-11-16","2021-11-17","2021-09-23","2021-11-17","2021-10-13","2021-10-13","2021-11-02","2021-11-02","2021-11-02"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",null,"",null,null,null,null,null,null,null,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":[["","00093100301","BUSPIRONE","15MG","180","Select","Select",""],["","68382050010","OMEPRAZOLE","40MG","90","Select","Select",""],["","64380080707","IBUPROFEN","800MG","-30","Select","Select",""],["","00093101042","MUPIROCIN","2%","-22","Select","Select",""],["","59762500801","MISOPROSTOL","200MCG","4","Select","Select",""],["","59267100001","PFIZER","COVID-19","0","Select","Select",""],["","00093100301","BUSPIRONE ","15MG","180","Select","Select",""],["","68382050010","OMEPRAZOLE ","40MG","-90","Select","Select",""],["","64380080707","IBUPROFEN ","800MG","30","Select","Select",""],["","59762500801","MISOPROSTOL ","200MCG","4","Select","Select",""],["","59267100001","PFIZER ","COVID-19","0","Select","Select",""],["","00093101042","MUPIROCIN ","2%","-22","Select","Select",""],["","53885024450","ONETOUCH","ULTRA","150","Select","Select",""],["","53885024450","ONETOUCH ","TES ULTRA","150","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":""}]}]}