{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ROBYN   K ROBERTSON","gend":1,"add":"1001 BROWARD WAY","city":"CHESAPEAKE","state":"VA","zip":"23322-9998","dob":"1965-10-08","age":"","mstatus":"","insh":"1953266*02","cliId":"","pno":"757\/408-0831","cno":"757\/408-0831","email":"","ename":"","eno":"","pphy":"LAPLACE, LEA SOLINAP MD","ppno":"757\/623-6072","pcpadd":"426 E FREEMASON ST","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23510,"pcpcounty":"","pcpid":100004,"pcpname":"Associates in Primary Care, PC","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"757\/410-1288","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/623-9748","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z00.00","Z12.31","Z23.","Z12.4","Z11.51","Z01.419","E03.9","E66.9","Z87.891","H40.013","H40.053","H52.11","H52.223","H52.4","F39.","G47.33","L29.0","L30.4","L81.8","R13.10","K21.9","Z86.010","R63.4","R11.0","J01.90","L73.8","Z11.59","N39.0","Z20.828","K21.00","J45.20","K44.9","F32.9","G47.30","Q27.30","O90.6","J45.31","J40.","J45.21","Q28.2","S00.00XA","J11.1","F29.","F43.10","F41.1","F31.81","N95.2","J45.30","E04.0","R07.9","R06.02","R68.84","B37.3","E04.1","R07.89","R03.0","E78.00","J45.909","Z79.899","Z68.41","Z79.890","M79.601","R10.11","E55.9","R47.89","H43.813","J01.80"],"date":["2021-07-20","2021-07-20","2020-07-15","2020-07-15","2020-07-15","2021-07-20","2021-09-13","2021-08-10","2021-08-17","2021-04-13","2021-04-13","2020-11-05","2020-11-05","2021-04-13","2021-09-01","2021-07-07","2020-11-05","2020-11-05","2020-11-05","2021-09-23","2021-09-23","2021-09-23","2021-09-23","2021-09-23","2020-12-21","2020-12-21","2021-03-05","2020-07-15","2021-03-05","2021-09-23","2021-03-05","2021-08-17","2021-08-17","2021-08-17","2021-08-17","2021-08-17","2021-04-16","2020-03-11","2020-02-05","2020-03-24","2020-03-24","2020-03-11","2020-11-23","2021-10-04","2021-10-04","2021-10-04","2021-07-20","2021-08-17","2021-08-17","2021-08-11","2021-08-10","2021-08-10","2021-08-17","2021-09-13","2021-08-10","2021-08-10","2021-08-10","2021-08-10","2021-08-10","2021-08-10","2021-08-10","2021-08-10","2021-09-23","2021-09-13","2021-09-02","2021-04-13","2021-11-01"],"priorHcc":["","","","","","","","","",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":[["","68382013805","TOPIRAMATE","25MG","180","Select","Select",""],["","68462013801","OXCARBAZEPIN","300MG","60","Select","Select",""],["","42192032801","NP","120MG","90","Select","Select",""],["","65862069790","VENLAFAXINE","150MG ER","90","Select","Select",""],["","50111043302","TRAZODONE","50MG","180","Select","Select",""],["","00781808926","AZITHROMYCIN","250MG","6","Select","Select",""],["","59746000103","METHYLPRED","4MG","-21","Select","Select",""],["","31722088290","ROSUVASTATIN","5MG","90","Select","Select",""],["","00173068220","VENTOLIN","","18","Select","Select",""],["","59417010310","VYVANSE","30MG","30","Select","Select",""],["","00173071720","ADVAIR","230\/21","12","Select","Select",""],["","00406048410","APAP\/CODEINE","300-30MG","12","Select","Select",""],["","45802046564","KETOCONAZOLE","2%","-120","Select","Select",""],["","45802048526","FLUOCIN","0.01% SC","-118","Select","Select",""],["","16729013716","CLONAZEPAM","1MG","30","Select","Select",""],["","43598051030","ESOMEPRA","40MG DR","90","Select","Select",""],["","45802006405","TRIAMCINOLON","0.10%","-454","Select","Select",""],["","00574200802","NYSTOP","100000","-60","Select","Select",""],["","69452015120","VITAMIN","50000UNT","-12","Select","Select",""],["","31722072690","MONTELUKAST","10MG","30","Select","Select",""],["","66993001968","ALBUTEROL","HFA","18","Select","Select",""],["","69238126601","OSELTAMIVIR","75MG","10","Select","Select",""],["","00143980305","DOXYCYCL","100MG","14","Select","Select",""],["","68462013801","OXCARBAZEPIN ","300MG","60","Select","Select",""],["","65862069790","VENLAFAXINE ","150MG ER","90","Select","Select",""],["","68382013805","TOPIRAMATE ","25MG","180","Select","Select",""],["","50111043302","TRAZODONE ","50MG","180","Select","Select",""],["","42192032801","NP ","120MG","90","Select","Select",""],["","59417010310","VYVANSE ","30MG","30","Select","Select",""],["","59746000103","METHYLPRED ","4MG","21","Select","Select",""],["","00173071720","ADVAIR ","230\/21","12","Select","Select",""],["","00781808926","AZITHROMYCIN ","250MG","6","Select","Select",""],["","69238126601","OSELTAMIVIR ","75MG","10","Select","Select",""],["","31722088290","ROSUVASTATIN ","5MG","90","Select","Select",""],["","66993001968","ALBUTEROL ","HFA","18","Select","Select",""],["","69452015120","VITAMIN ","50000UNT","12","Select","Select",""],["","00173068220","VENTOLIN ","","-18","Select","Select",""],["","00406048410","APAP\/CODEINE ","300-30MG","-12","Select","Select",""],["","16729013716","CLONAZEPAM ","1MG","30","Select","Select",""],["","00574200802","NYSTOP ","100000","60","Select","Select",""],["","43598051030","ESOMEPRA ","40MG DR","90","Select","Select",""],["","45802046564","KETOCONAZOLE ","2%","120","Select","Select",""],["","45802048526","FLUOCIN ","0.01% SC","-118","Select","Select",""],["","45802006405","TRIAMCINOLON ","0.10%","454","Select","Select",""],["","00143980305","DOXYCYCL ","100MG","14","Select","Select",""],["","31722072690","MONTELUKAST ","10MG","30","Select","Select",""],["","69238183901","LEVOTHYROXIN ","175MCG","90","Select","Select",""],["","68462018135","CLOTRIMAZOLE ","1%","60","Select","Select",""],["","65862085901","FAMOTIDINE ","20MG","60","Select","Select",""],["","69238183901","LEVOTHYROXIN","175MCG","90","Select","Select",""],["","68462018135","CLOTRIMAZOLE","1%","60","Select","Select",""],["","65862085901","FAMOTIDINE","20MG","60","Select","Select",""],["","00093101042","MUPIROCIN","2%","22","Select","Select",""],["","65862042005","SMZ\/TMP","800-160","20","Select","Select",""],["","51672131201","MUPIROCIN ","OIN 0.02","15","Select","Select",""],["","49502010202","EPINEPHRINE ","INJ 0.3MG","2","Select","Select",""],["","65862042005","SMZ\/TMP ","TAB 800-160","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":""}]}]}