{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MEGAN   NICOLE WHITEHURST","gend":1,"add":"766 HECATE DR","city":"VIRGINIA BEACH","state":"VA","zip":"23454-9998","dob":"1984-10-30","age":"","mstatus":"","insh":"2003160*01","cliId":"","pno":"757\/510-4076","cno":"757\/510-4076","email":"","ename":"","eno":"","pphy":"BERCOWITZ, HARVEY H MD","ppno":"757\/721-1281","pcpadd":"1200 ATLANTIC SHORES DR","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23454,"pcpcounty":"","pcpid":158027,"pcpname":"","plan":"OHP","program":"ACA","lob":"Individual","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":["G35.","R53.83","E55.9","D18.00","M21.371","N80.0","G58.8","R51.9","R10.2","G89.4","Z79.891","N80.9","R03.0","R10.9","N92.0","I10.","F17.290","F41.1","F33.1","N94.6","R53.1","R20.2","D49.2","Z01.419","Z11.3","N93.9","G89.29","M32.9","G89.18","K66.0","Z20.822","Z00.00","F41.9","F32.9","R50.9","J02.9","F41.0","J30.9","G95.89","D18.09","R20.0","M54.2","G95.9","J45.909","F17.210","Z88.8","Z88.5","Z85.820","Z79.899","Z79.3","Z86.14","G97.1","Z98.890","Z86.018","Z53.09","R82.998","Z20.828","N81.4","B34.9","N12.","R11.2","R05.","R06.00","L90.5","D22.5","L82.1","L81.4","R07.9","R00.0","Z23.","R10.30","N30.00","Z90.710","Z90.722","Z90.79","Z87.81","Z87.891","N39.0","N83.12","N83.02","N80.3","N13.5","J45.20","R10.84","Z90.721","D36.11","Z11.59","M99.71","M54.12","D49.4","Z01.812","R10.31","Z87.448","R19.7","D36.10","N94.10","F52.0","R59.0","Z13.1","Z13.29","Z13.220","F30.9","R11.0"],"date":["2021-09-03","2021-09-03","2021-09-03","2020-07-17","2020-07-17","2020-10-15","2020-10-20","2020-10-19","2021-08-06","2021-03-12","2021-03-12","2021-09-10","2020-09-14","2021-05-21","2020-12-08","2021-10-08","2021-09-10","2020-11-19","2020-11-19","2020-12-08","2020-07-29","2020-10-16","2020-10-22","2020-09-11","2020-09-11","2020-11-23","2021-09-10","2021-01-13","2020-12-11","2020-12-11","2021-01-25","2021-03-26","2021-06-18","2021-10-08","2021-05-10","2021-05-13","2021-06-18","2021-09-10","2020-07-17","2020-07-17","2020-08-11","2020-10-22","2020-08-11","2020-08-11","2020-10-19","2021-05-12","2021-05-12","2021-05-12","2020-12-01","2020-12-01","2021-05-12","2020-10-19","2021-05-12","2020-10-19","2020-11-23","2020-11-23","2020-11-28","2020-12-01","2021-11-01","2021-05-21","2021-05-13","2021-05-21","2021-05-21","2020-09-11","2020-09-11","2020-09-11","2020-09-11","2020-09-25","2020-09-25","2021-09-10","2021-05-12","2021-05-12","2021-05-12","2021-05-12","2021-05-12","2021-05-12","2021-05-12","2020-02-23","2020-12-01","2020-12-01","2020-12-01","2020-12-01","2020-12-01","2020-12-02","2020-12-02","2021-07-14","2021-05-10","2020-08-11","2020-08-11","2020-10-16","2020-11-20","2021-05-12","2021-05-12","2020-03-13","2021-07-14","2021-08-06","2021-08-06","2021-09-03","2021-09-03","2021-09-03","2021-09-03","2021-10-08","2021-10-08"],"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":[["","58468021004","AUBAGIO","14MG","30","Select","Select",""],["","65162062711","TRAMADOL","50MG","120","Select","Select",""],["","68180032002","BUPROPN","300MG XL","30","Select","Select",""],["","00378047705","DIAZEPAM","10MG","-60","Select","Select",""],["","13811071910","NITROFURANTN","100MG","14","Select","Select",""],["","13107015790","PAROXETINE","40MG","45","Select","Select",""],["","68382013201","TAMSULOSIN","0.4MG","30","Select","Select",""],["","70700011985","ESTARYLLA","0.25-35","84","Select","Select",""],["","10702000350","PROMETHAZINE","25MG","30","Select","Select",""],["","27808003502","HYDROCO\/APAP","5-325MG","30","Select","Select",""],["","10135062001","PHENAZOPYRID","100MG","-15","Select","Select",""],["","66530025320","TRETINOIN","0.03%","20","Select","Select",""],["","69452015120","VITAMIN","50000UNT","12","Select","Select",""],["","00093314505","CEPHALEXIN","250MG","20","Select","Select",""],["","00069047103","CHANTIX","0.5& 1MG","53","Select","Select",""],["","65862020299","LOSARTAN","50MG","-90","Select","Select",""],["","65162010150","GABAPENTIN","100MG","-90","Select","Select",""],["","00904645760","DOK","100MG","60","Select","Select",""],["","68462010630","ONDANSETRON","8MG","-30","Select","Select",""],["","31722054301","INDOMETHACIN","50MG","90","Select","Select",""],["","69315090405","LORAZEPAM","0.5MG","60","Select","Select",""],["","00054029399","AZELASTINE","0.10%","-30","Select","Select",""],["","00054001829","PREDNISONE","20MG","12","Select","Select",""],["","69097084905","ESCITALOPRAM","20MG","90","Select","Select",""],["","13668000801","ZOLPIDEM","10MG","10","Select","Select",""],["","00173068220","VENTOLIN","","18","Select","Select",""],["","60846050201","PYRIDIUM","200MG","6","Select","Select",""],["","00406051205","OXYCOD\/APAP","5-325MG","30","Select","Select",""],["","00115174501","METAXALONE","400MG","90","Select","Select",""],["","69097014260","ALBUTEROL","HFA","13","Select","Select",""],["","00406055201","OXYCODONE","5MG","12","Select","Select",""],["","65862077685","MILI","0.25\/35","84","Select","Select",""],["","00781185220","AMOX\/K","875-125","20","Select","Select",""],["","65162062711","TRAMADOL ","50MG","120","Select","Select",""],["","58468021004","AUBAGIO ","14MG","-30","Select","Select",""],["","13107015790","PAROXETINE ","40MG","45","Select","Select",""],["","10702000350","PROMETHAZINE ","25MG","-30","Select","Select",""],["","70700011985","ESTARYLLA ","0.25-35","84","Select","Select",""],["","68382013201","TAMSULOSIN ","0.4MG","30","Select","Select",""],["","68180032002","BUPROPN ","300MG XL","30","Select","Select",""],["","00406012305","HYDROCO\/APAP ","5-325MG","15","Select","Select",""],["","00378047705","DIAZEPAM ","10MG","60","Select","Select",""],["","10135062001","PHENAZOPYRID ","100MG","-15","Select","Select",""],["","13811071910","NITROFURANTN ","100MG","-14","Select","Select",""],["","66530025320","TRETINOIN ","0.03%","20","Select","Select",""],["","69452015120","VITAMIN ","50000UNT","-12","Select","Select",""],["","65162010250","GABAPENTIN ","300MG","-90","Select","Select",""],["","31722054301","INDOMETHACIN ","50MG","90","Select","Select",""],["","00591024205","LORAZEPAM ","2MG","2","Select","Select",""],["","65862020299","LOSARTAN ","50MG","-30","Select","Select",""],["","00093314505","CEPHALEXIN ","250MG","20","Select","Select",""],["","00069046903","CHANTIX ","1MG","112","Select","Select",""],["","00904645760","DOK ","100MG","60","Select","Select",""],["","68462010630","ONDANSETRON ","8MG","30","Select","Select",""],["","00115174501","METAXALONE ","400MG","90","Select","Select",""],["","00406051205","OXYCOD\/APAP ","5-325MG","30","Select","Select",""],["","13668000801","ZOLPIDEM ","10MG","10","Select","Select",""],["","00406055201","OXYCODONE ","5MG","12","Select","Select",""],["","65862077685","MILI ","0.25\/35","84","Select","Select",""],["","69097084905","ESCITALOPRAM ","20MG","30","Select","Select",""],["","00591544305","PREDNISONE ","20MG","12","Select","Select",""],["","60505083305","AZELASTINE ","0.10%","90","Select","Select",""],["","69097014260","ALBUTEROL ","HFA","13","Select","Select",""],["","60846050201","PYRIDIUM ","200MG","6","Select","Select",""],["","00173068220","VENTOLIN ","","18","Select","Select",""],["","00555097202","AMPHET\/DEXTR ","10MG","30","Select","Select",""],["","00781185220","AMOX\/K ","875-125","20","Select","Select",""],["","00555097202","AMPHET\/DEXTR","10MG","30","Select","Select",""],["","65862001305","SERTRALINE","100MG","30","Select","Select",""],["","65862001305","SERTRALINE ","TAB 100MG","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":""}]}]}