{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"STUART WASH","gend":0,"add":"402 OLD LANDING ROAD YORKTOWN","city":"YORKTOWN","state":"VA","zip":"23692-9998","dob":"1961-02-11","age":"","mstatus":"","insh":"1997139*01","cliId":"","pno":"757\/848-3907","cno":"757\/848-3907","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":"","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":["M25.511","E83.110","I25.10","Z95.5","I11.9","E78.5","I10.","Z12.5","E78.00","R09.81","J34.2","J34.3","J34.89","D53.9","D72.819","Z23.","J30.89","Z20.828","M21.6X1","M21.6X2","M77.9","L50.0","S43.421S","F32.0","F41.1","I49.3","Z47.89","M65.811","M19.011","Z98.890","M75.91","Z00.00","K21.9","Z01.818","D72.818","D64.9","E83.10","R20.2","L82.1","D22.9","L81.4","I78.1","Z71.9","M75.21","D31.32","H35.363","H25.13","H04.123","I49.1","I35.8","I47.1","H93.8X2","M75.111","M75.41","G89.18","Z01.810","R94.31","R10.31","Z90.89","J30.81","H00.015"],"date":["2020-02-26","2021-09-01","2021-04-26","2020-01-31","2020-01-31","2020-01-31","2021-04-26","2021-04-26","2021-04-26","2021-03-19","2021-02-16","2021-02-16","2020-10-29","2021-05-17","2021-08-09","2021-05-12","2021-08-26","2020-06-22","2020-10-09","2020-10-09","2020-10-09","2021-02-16","2021-02-10","2021-04-26","2021-04-26","2021-03-16","2020-07-20","2020-08-10","2020-08-10","2020-08-10","2020-08-10","2020-10-20","2021-04-26","2020-10-20","2020-02-17","2021-08-09","2020-06-08","2020-08-13","2020-08-13","2020-10-01","2020-08-13","2020-08-13","2020-08-13","2020-10-21","2020-10-01","2020-10-01","2020-10-01","2020-10-01","2021-03-16","2021-03-16","2021-03-16","2020-02-15","2020-10-21","2020-10-21","2020-10-21","2020-10-26","2020-10-26","2021-07-22","2021-07-22","2021-08-26","2021-08-20"],"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":[["","31722088530","ROSUVASTATIN","40MG","90","Select","Select",""],["","55111012405","ATORVASTATIN","80MG","90","Select","Select",""],["","68180072103","AMLODIPINE","10MG","90","Select","Select",""],["","00228202996","ALPRAZOLAM","0.5MG","30","Select","Select",""],["","43598057330","TADALAFIL","20MG","9","Select","Select",""],["","65862001105","SERTRALINE","25MG","-60","Select","Select",""],["","50111043302","TRAZODONE","50MG","180","Select","Select",""],["","61314064610","NEO\/POLY\/HC","1% OTIC","10","Select","Select",""],["","66685100100","AMOX\/K","875-125","20","Select","Select",""],["","69543025216","VIRTUSSIN","100-10\/5","-120","Select","Select",""],["","00121077504","GG\/CODEINE","100-10\/5","-120","Select","Select",""],["","64380071206","BENZONATATE","100MG","21","Select","Select",""],["","00406012305","HYDROCO\/APAP","5-325MG","30","Select","Select",""],["","57237000299","HYDROCHLOROT","12.5MG","90","Select","Select",""],["","00591544305","PREDNISONE","20MG","-10","Select","Select",""],["","00591207030","LIDO\/PRILOCN","2.5-2.5%","-30","Select","Select",""],["","00093314705","CEPHALEXIN","500MG","14","Select","Select",""],["","68462010530","ONDANSETRON","4MG","10","Select","Select",""],["","00406051205","OXYCOD\/APAP","5-325MG","40","Select","Select",""],["","75834019701","HC","2.5-1%","30","Select","Select",""],["","00781569031","EZETIMIBE","10MG","-30","Select","Select",""],["","59746000103","METHYLPRED","4MG","21","Select","Select",""],["","59267100001","PFIZER","COVID-19","0","Select","Select",""],["","68462019005","NAPROXEN","500MG","60","Select","Select",""],["","31722088530","ROSUVASTATIN ","40MG","90","Select","Select",""],["","55111012405","ATORVASTATIN ","80MG","90","Select","Select",""],["","68180072103","AMLODIPINE ","10MG","90","Select","Select",""],["","61314064610","NEO\/POLY\/HC ","1% OTIC","10","Select","Select",""],["","50111043302","TRAZODONE ","50MG","180","Select","Select",""],["","65862001205","SERTRALINE ","50MG","-90","Select","Select",""],["","00228202996","ALPRAZOLAM ","0.5MG","30","Select","Select",""],["","43598057330","TADALAFIL ","20MG","9","Select","Select",""],["","00591544305","PREDNISONE ","20MG","-10","Select","Select",""],["","64380071206","BENZONATATE ","100MG","-30","Select","Select",""],["","66685100100","AMOX\/K ","875-125","20","Select","Select",""],["","69543025216","VIRTUSSIN ","100-10\/5","120","Select","Select",""],["","00121077504","GG\/CODEINE ","100-10\/5","120","Select","Select",""],["","68462010530","ONDANSETRON ","4MG","10","Select","Select",""],["","59746000103","METHYLPRED ","4MG","21","Select","Select",""],["","68462019005","NAPROXEN ","500MG","60","Select","Select",""],["","00406012305","HYDROCO\/APAP ","5-325MG","30","Select","Select",""],["","00093314705","CEPHALEXIN ","500MG","14","Select","Select",""],["","00406051205","OXYCOD\/APAP ","5-325MG","40","Select","Select",""],["","57237000299","HYDROCHLOROT ","12.5MG","-90","Select","Select",""],["","00591207030","LIDO\/PRILOCN ","2.5-2.5%","30","Select","Select",""],["","00781569031","EZETIMIBE ","10MG","-30","Select","Select",""],["","75834019701","HC ","2.5-1%","30","Select","Select",""],["","59267100001","PFIZER ","COVID-19","0","Select","Select",""],["","60505083305","AZELASTINE ","0.10%","30","Select","Select",""],["","00574402435","ERYTHROMYCIN ","5MG\/GM","4","Select","Select",""],["","60505083305","AZELASTINE","0.10%","30","Select","Select",""],["","00574402435","ERYTHROMYCIN","5MG\/GM","-4","Select","Select",""],["","68382013201","TAMSULOSIN","0.4MG","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","",""],["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":""}]}]}