{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KEVIN   S HOWELL","gend":0,"add":"504 CEDAR CT","city":"SUFFOLK","state":"VA","zip":"23437-9998","dob":"1989-05-02","age":"","mstatus":"","insh":"1943592*01","cliId":"","pno":"757\/404-2444","cno":"757\/404-2444","email":"","ename":"","eno":"","pphy":"JONES, SHAVON C MD","ppno":"757\/925-1866","pcpadd":"157 N MAIN ST","pcpcity":"SUFFOLK","pcpstate":"VA","pcpzip":23434,"pcpcounty":"","pcpid":116807,"pcpname":"","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/928-0902","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R55.","R06.02","F11.20","F14.10","Z72.89","F17.200","F19.10","G47.00","F32.9","R53.83","Z51.81","Z13.89","F10.10","B35.9","R76.8","F14.20","K21.9","B19.20","Z87.891","T39.1X1A","F11.10","Z11.3","T50.901A","R40.0","R62.50","Z90.49","F19.20","F12.20","B18.2","K59.03","Z11.59","R07.89","F41.1","Z56.6","F39.","Z13.31","Z68.21"],"date":["2020-01-10","2021-07-22","2021-01-19","2020-12-10","2020-10-01","2020-12-10","2021-07-26","2020-10-01","2020-10-01","2020-10-01","2020-12-10","2020-12-10","2020-12-10","2020-11-18","2020-11-18","2021-11-08","2021-07-26","2021-07-22","2021-04-02","2020-01-10","2020-01-10","2021-07-26","2020-01-10","2020-01-10","2020-01-10","2020-01-10","2021-01-14","2021-01-19","2021-03-11","2020-09-10","2021-03-11","2021-07-22","2021-07-22","2021-07-22","2021-07-26","2021-07-26","2021-07-26"],"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":[["","00591024005","LORAZEPAM","0.5MG","12","Select","Select",""],["","16729008110","NALTREXONE","50MG","30","Select","Select",""],["","59310057922","PROAIR","","-8","Select","Select",""],["","57237007710","ONDANSETRON","4MG ODT","12","Select","Select",""],["","68382004001","PROMETHAZINE","12.5MG","12","Select","Select",""],["","47781035603","BUPREN\/NALOX","4-1MG","5","Select","Select",""],["","00093317431","ALBUTEROL","HFA","8","Select","Select",""],["","11917001257","SALINE","0.65%","88","Select","Select",""],["","69547035302","NARCAN","","-2","Select","Select",""],["","00363053201","MUCUS","400MG","12","Select","Select",""],["","12496120803","SUBOXONE","8-2MG","5","Select","Select",""],["","00085411201","AFRIN","0.05%","15","Select","Select",""],["","68462018117","CLOTRIMAZOLE","1%","15","Select","Select",""],["","62175011843","OMEPRAZOLE","20MG","90","Select","Select",""],["","43547028910","BUPROPION","150MG SR","81","Select","Select",""],["","00173072200","WELLBUTRIN","200MG SR","56","Select","Select",""],["","00591024005","LORAZEPAM ","0.5MG","12","Select","Select",""],["","68382004001","PROMETHAZINE ","12.5MG","12","Select","Select",""],["","57237007710","ONDANSETRON ","4MG ODT","12","Select","Select",""],["","43598057930","BUPREN\/NALOX ","2-0.5MG","6","Select","Select",""],["","16729008110","NALTREXONE ","50MG","30","Select","Select",""],["","59310057922","PROAIR ","","-8","Select","Select",""],["","00093317431","ALBUTEROL ","HFA","8","Select","Select",""],["","00363053201","MUCUS ","400MG","12","Select","Select",""],["","00085411201","AFRIN ","0.05%","15","Select","Select",""],["","11917001257","SALINE ","0.65%","88","Select","Select",""],["","43547028910","BUPROPION ","150MG SR","81","Select","Select",""],["","69547035302","NARCAN ","","2","Select","Select",""],["","68462018117","CLOTRIMAZOLE ","1%","15","Select","Select",""],["","12496120803","SUBOXONE ","8-2MG","14","Select","Select",""],["","00173072200","WELLBUTRIN ","200MG SR","56","Select","Select",""],["","62175011843","OMEPRAZOLE ","20MG","90","Select","Select",""],["","23155050105","HYDROXYZ ","25MG","30","Select","Select",""],["","27241009803","DULOXETINE ","30MG","-30","Select","Select",""],["","27241009803","DULOXETINE","30MG","30","Select","Select",""],["","23155050105","HYDROXYZ","25MG","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","",""],["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":""}]}]}