{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" DARLENE LONDEREE","gend":1,"add":"4135 BEECHLAND ROAD","city":"ELBERON","state":"VA","zip":"23846-9998","dob":"1962-05-26","age":"","mstatus":"","insh":"2004703*01","cliId":"","pno":"757\/209-1583","cno":"757\/209-1583, ","email":"","ename":"","eno":"","pphy":"WILLIAMS, VALENCIA J MD","ppno":"757\/294-3981","pcpadd":"440 COLONIAL TRL W","pcpcity":"DENDRON","pcpstate":"VA","pcpzip":"23839-9998","pcpcounty":"","pcpid":671580,"pcpname":"","plan":"OHP - OPTIMA","program":"ACA","lob":"Individual","region":"CENTRAL","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":["R42.","M79.18","M47.899","M48.061","Z79.899","Z96.653","M47.816","M19.041","M19.042","M06.4","Z15.89","M25.50","Z79.1","R91.8","R50.9","R52.","E55.9","M85.89","E03.9","Z00.00","Z13.220","R22.2","R93.89","M45.0","Z68.31","M81.0","M54.5","M53.3","G89.29","M70.61","M70.62","R05.","M45.6","J02.9","M17.11","Z96.651","E78.2","R87.610","R21.","Z12.39","Z12.11","M47.812","M43.12","M47.814","R10.2","M13.89","Z79.52","M06.09","M79.632","M25.532","T14.90XA","M15.0","M79.7","F51.01","Z86.14","R20.0"],"date":["2020-12-15","2021-01-05","2021-04-08","2021-01-05","2021-04-08","2021-01-05","2020-12-10","2020-01-07","2020-01-07","2020-01-07","2020-01-07","2020-12-10","2020-10-02","2020-10-26","2021-01-25","2021-01-25","2021-05-19","2021-05-19","2020-12-10","2020-07-10","2020-07-10","2020-07-17","2020-10-28","2020-10-28","2020-10-28","2021-06-02","2020-02-20","2020-01-21","2020-01-21","2020-01-21","2020-01-21","2020-07-10","2021-01-25","2020-02-03","2020-05-21","2020-12-18","2020-12-10","2020-07-10","2020-07-10","2020-07-10","2020-08-31","2020-06-10","2020-02-20","2020-02-20","2020-02-20","2020-10-02","2020-02-19","2020-06-10","2020-12-18","2020-12-18","2020-12-18","2020-10-02","2020-10-02","2020-12-10","2020-12-18","2020-12-18"],"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":[["","59762500001","SULFASALAZIN","500MG","180","Select","Select",""],["","70710122600","AMITRIPTYLIN","25MG","30","Select","Select",""],["","00591505210","PREDNISONE","5MG","30","Select","Select",""],["","65862064169","AZITHROMYCIN","250MG","-6","Select","Select",""],["","69238183107","LEVOTHYROXIN","50MCG","30","Select","Select",""],["","31722072690","MONTELUKAST","10MG","30","Select","Select",""],["","64380071206","BENZONATATE","100MG","30","Select","Select",""],["","29300012510","MELOXICAM","15MG","30","Select","Select",""],["","66993001968","ALBUTEROL","HFA","18","Select","Select",""],["","43598081115","CETIRIZINE","10MG","30","Select","Select",""],["","78112001106","CHLORASEPTIC","6-10MG","18","Select","Select",""],["","69543025216","VIRTUSSIN","100-10\/5","180","Select","Select",""],["","00173068220","VENTOLIN","","18","Select","Select",""],["","65862016001","ZOLPIDEM","10MG","30","Select","Select",""],["","68462012605","GABAPENTIN","600MG","90","Select","Select",""],["","62542030117","HYD","10-8\/5ML","100","Select","Select",""],["","00378875006","DICLOFENAC","1%","-100","Select","Select",""],["","51672128202","TRIAMCINOLON","0.10%","-60","Select","Select",""],["","00527133001","BACLOFEN","10MG","60","Select","Select",""],["","00093720298","PRAVASTATIN","40MG","90","Select","Select",""],["","50474071081","CIMZIA","STARTER","3","Select","Select",""],["","59746012106","MECLIZINE","25MG","60","Select","Select",""],["","0","","","-43","Select","Select",""],["","63275990104","NALTREXONE","HCL","90","Select","Select",""],["","57237007710","ONDANSETRON","4MG ODT","30","Select","Select",""],["","17478071710","KETOTIF","0.025%OP","5","Select","Select",""],["","60505082901","FLUTICASONE","50MCG","16","Select","Select",""],["","59746000103","METHYLPRED","4MG","-21","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":""}]}]}