{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"VIKKI VANDERPOOL","gend":1,"add":"737 LORD NELSON DR","city":"VIRGINIA BEACH","state":"VA","zip":"23464-9998","dob":"1970-10-14","age":"","mstatus":"","insh":"1934534*01","cliId":"","pno":"757\/693-2135","cno":"757\/693-2135","email":"","ename":"","eno":"","pphy":"SALSANO, ALESSIO C MD","ppno":"757\/495-4353","pcpadd":"5265 PROVIDENCE RD STE 401","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23464,"pcpcounty":"","pcpid":210630,"pcpname":"","plan":"OHP","program":"ACA","lob":"Individual","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/495-4560","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M46.1","M79.10","G89.29","M54.5","M47.816","M79.672","Z98.890","M72.2","M13.872","M25.572","F33.1","M60.9","K80.12","R07.89","I25.10","I21.4","Z01.419","Z01.818","M79.18","K81.0","I10.","Z90.710","F41.9","R10.13","M19.90","Z20.828","R10.32","R10.9","E83.52","R53.83","R19.7","K80.20","R79.89","R07.9","R93.5","K80.50","M13.871","Z98.1","M24.672","M25.872","M84.375A","M47.817","T14.90XA","R07.81","Z12.31","M19.072","M96.0","Z03.818","R05.","R50.9","G43.909","M47.9","M16.0","M17.11","F32.9","J45.909","Z79.1","Z79.899","Z88.6","Z88.1","Z91.040","Z88.5","Z88.0","R06.02","M76.72","Z20.822","N30.00","M79.673","G89.4","Z88.8","Z88.4","Z88.2","S29.9XXA","Z01.810","Z01.811","Z01.812","Z11.59","F41.8","Z96.651","Z91.048","J06.9","R09.81","J02.9","R10.11","Z00.00","S92.902K","Z03.89","J90.","Z90.49","Z91.09","M54.9","E66.9","K59.00","Z68.32","R77.8","G43.801","R19.00","S82.842K","T84.84XA","Z47.2","R10.84","R11.0","R93.2","K81.9","M76.70","K91.5","K58.0","K52.9","K64.8","K29.70","K44.9","Z68.31","K58.8","K59.03","K30.","J01.90","G43.919","R35.0","R05.1","N95.2","M24.873","N89.8"],"date":["2021-09-29","2021-09-29","2021-09-29","2021-09-29","2021-03-17","2021-11-11","2020-08-06","2021-10-19","2021-04-19","2021-11-03","2020-12-09","2021-01-04","2021-02-19","2021-03-10","2021-03-04","2021-03-04","2021-06-28","2020-06-24","2021-07-27","2021-02-24","2021-11-12","2021-10-12","2021-02-24","2021-03-10","2021-03-17","2021-10-26","2021-04-14","2021-05-01","2021-04-20","2021-04-20","2021-09-22","2021-02-18","2021-03-05","2021-03-05","2021-03-08","2021-03-09","2020-02-10","2021-11-03","2020-03-06","2020-03-06","2020-03-06","2020-04-10","2020-06-08","2021-03-04","2021-06-28","2020-07-17","2020-07-17","2020-08-19","2020-09-14","2020-09-14","2021-04-14","2021-02-18","2021-02-18","2021-02-18","2021-03-04","2021-04-14","2021-02-18","2021-02-18","2021-02-18","2021-04-14","2021-04-14","2021-04-14","2021-04-14","2021-03-04","2021-04-19","2021-03-25","2021-04-14","2021-04-14","2021-04-14","2021-04-14","2021-04-14","2021-04-14","2020-06-08","2020-06-24","2020-06-24","2020-07-15","2020-07-15","2020-07-17","2021-03-04","2020-07-17","2020-09-14","2020-09-14","2020-09-14","2021-09-17","2020-07-14","2020-11-05","2021-02-19","2021-02-24","2021-03-10","2021-02-24","2021-02-24","2021-03-04","2021-11-09","2021-03-04","2021-03-05","2021-03-05","2021-03-05","2020-07-17","2020-07-17","2020-07-17","2021-03-02","2021-08-13","2021-03-08","2021-04-13","2021-04-19","2021-05-11","2021-08-13","2021-06-16","2021-06-16","2021-06-16","2021-06-16","2021-06-28","2021-08-13","2021-08-13","2021-08-03","2021-08-30","2021-08-30","2021-10-07","2021-10-26","2021-10-12","2021-11-12","2021-10-07"],"priorHcc":[null,null,null,null,"",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":[["","43598029490","PREGABALIN","100MG","60","Select","Select",""],["","00002327030","CYMBALTA","60MG","30","Select","Select",""],["","55111034101","AMLOD\/BENAZP","10-20MG","-30","Select","Select",""],["","52817032010","BACLOFEN","10MG","-90","Select","Select",""],["","68382005101","MELOXICAM","15MG","-30","Select","Select",""],["","68180061307","QUETIAPINE","150MG ER","90","Select","Select",""],["","59746000103","METHYLPRED","4MG","21","Select","Select",""],["","59148003713","REXULTI","1MG","30","Select","Select",""],["","51862049460","FLUOCINONIDE","0.05%","60","Select","Select",""],["","10702001250","HYDROXYZ","50MG","60","Select","Select",""],["","69238126601","OSELTAMIVIR","75MG","10","Select","Select",""],["","43386035701","HYDROCO\/APAP","7.5-325","90","Select","Select",""],["","51991074890","DULOXETINE","60MG","30","Select","Select",""],["","68462010530","ONDANSETRON","4MG","40","Select","Select",""],["","00093310953","AMOXICILLIN","500MG","20","Select","Select",""],["","68462010340","FLUCONAZOLE","150MG","1","Select","Select",""],["","49281042050","FLUZONE","2020-21","0","Select","Select",""],["","60432026415","FLUTICASONE","50MCG","48","Select","Select",""],["","00143122701","DICYCLOMINE","20MG","30","Select","Select",""],["","00093005805","TRAMADOL","50MG","40","Select","Select",""],["","60505384901","CELECOXIB","200MG","30","Select","Select",""],["","55111015810","OMEPRAZOLE","20MG","30","Select","Select",""],["","50111033401","METRONIDAZOL","500MG","30","Select","Select",""],["","00395813956","CHOLESTYRAMI","RESIN","500","Select","Select",""],["","65862053750","LEVOFLOXACIN","500MG","10","Select","Select",""],["","00115132019","COLESEVELAM","625MG","90","Select","Select",""],["","00406324301","HYDROMORPHON","2MG","40","Select","Select",""],["","57896090110","ASPIRIN","325MG","28","Select","Select",""],["","65162019010","NAPROXEN","500MG","60","Select","Select",""],["","00172392670","DIAZEPAM","5MG","20","Select","Select",""],["","68180012201","CEPHALEXIN","500MG","12","Select","Select",""],["","64380071206","BENZONATATE","100MG","30","Select","Select",""],["","60432027516","BROM\/PSE\/DM","","240","Select","Select",""],["","49281072010","FLUBLOK","2020-21","0","Select","Select",""],["","50428209452","MAG","LEMON","296","Select","Select",""],["","62175061743","PANTOPRAZOLE","40MG","90","Select","Select",""],["","10702001801","OXYCODONE","5MG","8","Select","Select",""],["","88888888887","DMR","","1","Select","Select",""],["","59746012106","MECLIZINE","25MG","30","Select","Select",""],["","50428166363","BISACODYL","5MG EC","2","Select","Select",""],["","43199001401","HYOSCYAMINE","0.375 ER","180","Select","Select",""],["","65862007701","CIPROFLOXACN","500MG","20","Select","Select",""],["","43598029490","PREGABALIN ","100MG","60","Select","Select",""],["","68180061307","QUETIAPINE ","150MG ER","90","Select","Select",""],["","55111034101","AMLOD\/BENAZP ","10-20MG","-30","Select","Select",""],["","52817032010","BACLOFEN ","10MG","-90","Select","Select",""],["","00002327030","CYMBALTA ","60MG","90","Select","Select",""],["","68382005101","MELOXICAM ","15MG","30","Select","Select",""],["","65162011510","HYDROCO\/APAP ","7.5-325","90","Select","Select",""],["","69238126601","OSELTAMIVIR ","75MG","10","Select","Select",""],["","59148003713","REXULTI ","1MG","30","Select","Select",""],["","59746000103","METHYLPRED ","4MG","21","Select","Select",""],["","10702001250","HYDROXYZ ","50MG","60","Select","Select",""],["","51862049460","FLUOCINONIDE ","0.05%","60","Select","Select",""],["","51991074890","DULOXETINE ","60MG","30","Select","Select",""],["","68462010530","ONDANSETRON ","4MG","40","Select","Select",""],["","00406324301","HYDROMORPHON ","2MG","40","Select","Select",""],["","57896090110","ASPIRIN ","325MG","28","Select","Select",""],["","60432027516","BROM\/PSE\/DM ","","240","Select","Select",""],["","60432026415","FLUTICASONE ","50MCG","48","Select","Select",""],["","31722072250","LEVOFLOXACIN ","500MG","10","Select","Select",""],["","65162019010","NAPROXEN ","500MG","60","Select","Select",""],["","00093226301","AMOXICILLIN ","500MG","30","Select","Select",""],["","68462010340","FLUCONAZOLE ","150MG","1","Select","Select",""],["","64380071206","BENZONATATE ","100MG","30","Select","Select",""],["","60505384901","CELECOXIB ","200MG","30","Select","Select",""],["","49281042050","FLUZONE ","2020-21","0","Select","Select",""],["","49281072010","FLUBLOK ","2020-21","0","Select","Select",""],["","68180012201","CEPHALEXIN ","500MG","12","Select","Select",""],["","10702001801","OXYCODONE ","5MG","8","Select","Select",""],["","59746012106","MECLIZINE ","25MG","-30","Select","Select",""],["","55111015810","OMEPRAZOLE ","20MG","30","Select","Select",""],["","00172392670","DIAZEPAM ","5MG","20","Select","Select",""],["","50111033401","METRONIDAZOL ","500MG","30","Select","Select",""],["","00093005805","TRAMADOL ","50MG","40","Select","Select",""],["","00395813919","CHOLESTYRAMI ","RESIN","25","Select","Select",""],["","00143122701","DICYCLOMINE ","20MG","30","Select","Select",""],["","65862007701","CIPROFLOXACN ","500MG","20","Select","Select",""],["","00115132019","COLESEVELAM ","625MG","90","Select","Select",""],["","62175061743","PANTOPRAZOLE ","40MG","90","Select","Select",""],["","43199001401","HYOSCYAMINE ","0.375 ER","180","Select","Select",""],["","50428209452","MAG ","LEMON","296","Select","Select",""],["","50428166363","BISACODYL ","5MG EC","2","Select","Select",""],["","88888888887","DMR ","","1","Select","Select",""],["","57841130001","MOVANTIK ","12.5MG","30","Select","Select",""],["","00254302902","LUBIPROSTONE ","24MCG","180","Select","Select",""],["","65649030302","XIFAXAN ","550MG","42","Select","Select",""],["","00603533815","PREDNISONE ","10MG","21","Select","Select",""],["","59267100003","PFIZER ","COVID-19","0","Select","Select",""],["","67877054360","CEFDINIR ","300MG","20","Select","Select",""],["","00254302902","LUBIPROSTONE","24MCG","180","Select","Select",""],["","65649030302","XIFAXAN","550MG","42","Select","Select",""],["","57841130001","MOVANTIK","12.5MG","30","Select","Select",""],["","00603533815","PREDNISONE","10MG","21","Select","Select",""],["","67877054360","CEFDINIR","300MG","20","Select","Select",""],["","59267100003","PFIZER","COVID-19","0","Select","Select",""],["","70710122600","AMITRIPTYLIN","25MG","30","Select","Select",""],["","51672130406","TERCONAZOLE","0.40%","45","Select","Select",""],["","69238110005","DOXYCYCL","100MG","20","Select","Select",""],["","00456120330","LINZESS ","CAP 72MCG","90","Select","Select",""],["","70710122600","AMITRIPTYLIN ","TAB 25MG","30","Select","Select",""],["","51672130406","TERCONAZOLE ","CRE 0.004","45","Select","Select",""],["","69238110005","DOXYCYCL ","CAP 100MG","20","Select","Select",""],["","67877021560","CEFUROXIME ","TAB 250MG","20","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":""}]}]}