{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ADRIAN WILLIAMS","gend":0,"add":"108 QUEENS XING","city":"WILLIAMSBURG","state":"VA","zip":"23185-9998","dob":"1978-06-15","age":"","mstatus":"","insh":"1993958*01","cliId":"","pno":"602\/373-6185","cno":"602\/373-6185","email":"","ename":"","eno":"","pphy":"BLANCHARD, JEFFREY G MD","ppno":"757\/707-3669","pcpadd":"132 PROFESSIONAL CIRCLE","pcpcity":"WILLIAMSBURG","pcpstate":"VA","pcpzip":23185,"pcpcounty":"","pcpid":157538,"pcpname":"WILLIAMSBURG FAMILY MEDICINE","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"","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":["R05.","J18.1","E10.65","Z96.41","E55.9","Z20.828","J06.9","R68.89","R53.83","Z11.4","Z11.59","E10.9","Z79.4","G47.19","R06.81","E11.59","E10.69","E66.01","R29.818","I10.","E78.5","Z68.36","M54.5","Z68.37","J18.9","E13.65","F41.9","M77.01","U07.1","J20.8","R82.4","R81.","E11.9","E10.649","Z04.9","E66.9","J02.9","E11.3293","H35.63","E11.65","J20.9","E86.0","R50.9","R09.81","K21.9","F41.8","Z87.442","Z00.00","G47.33","R00.0","R74.8","I15.2","I51.7","R06.02"],"date":["2020-03-15","2020-05-28","2020-04-21","2021-03-02","2021-10-26","2020-10-08","2020-09-02","2020-09-02","2021-03-05","2021-03-05","2021-03-05","2021-10-26","2021-09-29","2021-10-26","2021-04-16","2021-08-05","2021-08-05","2021-04-16","2021-05-05","2021-04-16","2021-08-05","2021-04-16","2021-07-18","2020-02-11","2020-05-28","2021-03-05","2021-10-26","2020-07-29","2020-09-09","2020-09-09","2021-03-05","2021-03-05","2021-08-05","2020-02-11","2021-03-02","2021-03-02","2020-03-15","2020-12-18","2020-12-18","2021-08-05","2020-10-08","2020-03-10","2020-03-15","2020-03-10","2020-03-10","2020-03-10","2020-03-10","2021-03-05","2021-10-15","2021-11-10","2021-08-11","2021-08-05","2021-11-10","2021-11-10"],"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":[["","00002850101","HUMULIN ","U-500","20","Select","Select",""],["","00002751001","HUMALOG ","100\/ML","14","Select","Select",""],["","00024586903","TOUJEO ","300IU\/ML","2","Select","Select",""],["","00173068220","VENTOLIN ","","18","Select","Select",""],["","08290320122","BD  PEN NEEDL","32GX4MM","100","Select","Select",""],["","00169406013","VICTOZA ","18MG\/3ML","27","Select","Select",""],["","13668013601","ESCITALOPRAM ","10MG","90","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","58657050016","CODEINE\/GG ","10-100\/5","120","Select","Select",""],["","53489011905","DOXYCYCL ","100MG","20","Select","Select",""],["","00254100752","ALBUTEROL ","HFA","7","Select","Select",""],["","00378967130","IPRATROPIUM\/ ","ALBUTER","120","Select","Select",""],["","65862053750","LEVOFLOXACIN ","500MG","7","Select","Select",""],["","00173071920","FLOVENT ","110MCG","12","Select","Select",""],["","10370010250","BUPROPN ","300MG XL","90","Select","Select",""],["","00904656461","BENZONATATE ","100MG","30","Select","Select",""],["","00173069600","ADVAIR ","250\/50","60","Select","Select",""],["","70377003012","ATORVASTATIN ","80MG","90","Select","Select",""],["","60505294509","EZETIMIBE ","10MG","90","Select","Select",""],["","65162075310","BENAZEPRIL ","20MG","90","Select","Select",""],["","00378932132","WIXELA ","250\/50","60","Select","Select",""],["","69452015120","VITAMIN ","50000UNT","12","Select","Select",""],["","80777027399","MODERNA ","COVID-19","0","Select","Select",""],["","00574022901","BENAZEP\/HCTZ ","20-12.5","90","Select","Select",""],["","68180016013","AZITHROMYCIN ","250MG","6","Select","Select",""],["","49281042050","FLUZONE ","2020-21","0","Select","Select",""],["","27241018860","METFORMIN ","500MG ER","360","Select","Select",""],["","59746000103","METHYLPRED ","4MG","21","Select","Select",""],["","88888888887","DMR ","","1","Select","Select",""],["","00591565810","CYCLOBENZAPR ","10MG","30","Select","Select",""],["","00002850101","HUMULIN","U-500","20","Select","Select",""],["","00173068220","VENTOLIN","","18","Select","Select",""],["","68382002210","ATENOLOL ","25MG","90","Select","Select",""],["","00002751001","HUMALOG","100\/ML","-30","Select","Select",""],["","00024586903","TOUJEO","300IU\/ML","9","Select","Select",""],["","08290320122","BD PEN NEEDL","32GX4MM","100","Select","Select",""],["","00169406013","VICTOZA","18MG\/3ML","27","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","13668013601","ESCITALOPRAM","10MG","90","Select","Select",""],["","10370010250","BUPROPN","300MG XL","90","Select","Select",""],["","53489011905","DOXYCYCL","100MG","20","Select","Select",""],["","58657050016","CODEINE\/GG","10-100\/5","120","Select","Select",""],["","00378967130","IPRATROPIUM\/","ALBUTER","180","Select","Select",""],["","65162075310","BENAZEPRIL","20MG","90","Select","Select",""],["","00254100752","ALBUTEROL","HFA","7","Select","Select",""],["","00173071920","FLOVENT","110MCG","36","Select","Select",""],["","65862053750","LEVOFLOXACIN","500MG","7","Select","Select",""],["","00904656461","BENZONATATE","100MG","30","Select","Select",""],["","00173069600","ADVAIR","250\/50","-60","Select","Select",""],["","00378932132","WIXELA","250\/50","60","Select","Select",""],["","70377003012","ATORVASTATIN","80MG","90","Select","Select",""],["","60505294509","EZETIMIBE","10MG","90","Select","Select",""],["","68180016013","AZITHROMYCIN","250MG","6","Select","Select",""],["","49281042050","FLUZONE","2020-21","0","Select","Select",""],["","88888888887","DMR","","1","Select","Select",""],["","69452015120","VITAMIN","50000UNT","12","Select","Select",""],["","00574022901","BENAZEP\/HCTZ","20-12.5","90","Select","Select",""],["","80777027399","MODERNA","COVID-19","0","Select","Select",""],["","27241018860","METFORMIN","500MG ER","360","Select","Select",""],["","00591565810","CYCLOBENZAPR","10MG","30","Select","Select",""],["","59746000103","METHYLPRED","4MG","21","Select","Select",""],["","68382002210","ATENOLOL","25MG","90","Select","Select",""],["","70461032103","FLUCLVX","2021-22","0","Select","Select",""],["","70461032103","FLUCLVX ","INJ 2021-22","0","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":[[["Yes","Select","","","","","Select","",""],["Yes","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":""}]}]}