{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DONNA WYNDER","gend":1,"add":"203 SAINT GEORGE DR","city":"YORKTOWN","state":"VA","zip":"23693-9998","dob":"1959-07-04","age":"","mstatus":"","insh":"2006529*01","cliId":"","pno":"757\/358-4540","cno":"757\/358-4540","email":"","ename":"","eno":"","pphy":"RAINES, TIMOTHY L MD","ppno":"757\/964-7629","pcpadd":"2240 D COLISEUM DR","pcpcity":"HAMPTON","pcpstate":"VA","pcpzip":23666,"pcpcounty":"","pcpid":510027,"pcpname":"","plan":"OHP","program":"ACA","lob":"Individual","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/964-7630","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R31.9","K11.5","K11.20","E66.3","Z23.","R00.2","R07.9","E66.09","E78.00","Z68.29","N39.0","R35.8","B37.0","B35.8","Z20.828","Z11.1","I49.3","R05.","R42.","H81.10","Z13.820","H00.019","J20.9","W54.0XXA","T14.8XXA","S20.369A","W57.XXXA","E78.5","Z00.00","R73.02","Z12.11","L40.9","R68.2","E55.9","L82.1","L57.8","D18.01","L81.4","Z85.828","L21.9","L29.9","L91.0","I83.93","H00.015","H04.123","H57.12","H00.15","S33.9XXA","M47.816","S39.012A","H35.363","H25.013","Z01.419","Z12.39","N81.89","Z11.51","I83.11","I83.12","Z12.31","Z83.71"],"date":["2021-05-28","2021-06-03","2021-06-03","2021-06-16","2020-11-12","2021-03-23","2021-03-12","2021-03-08","2021-03-08","2021-03-08","2020-03-24","2020-06-01","2020-06-01","2020-06-01","2020-05-08","2020-12-01","2021-03-12","2020-04-16","2020-08-27","2021-06-16","2020-07-15","2021-02-01","2020-04-16","2020-04-16","2020-06-23","2020-06-19","2020-06-19","2021-07-26","2021-06-16","2020-06-24","2021-10-29","2020-06-23","2020-06-23","2020-08-27","2021-03-10","2021-03-10","2021-03-10","2021-03-10","2021-03-10","2021-03-10","2021-03-10","2021-03-10","2021-06-16","2021-07-26","2021-08-09","2021-08-09","2021-08-09","2021-09-13","2021-09-13","2021-09-13","2021-09-20","2021-09-20","2021-09-29","2021-09-29","2021-09-29","2021-09-29","2021-11-24","2021-11-24","2021-10-22","2021-10-29"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",null,"","","","","","","","","","","","","","","","","","","","","",null,null,null,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":[["","69543025216","VIRTUSSIN","100-10\/5","-120","Select","Select",""],["","45802096126","CLOBETASOL","0.05%","118","Select","Select",""],["","42806031250","DOXYCYCL","100MG","20","Select","Select",""],["","00143992701","CIPROFLOXACN","250MG","14","Select","Select",""],["","69452014430","BENZONATATE","200MG","30","Select","Select",""],["","65162027250","SMZ\/TMP","800-160","14","Select","Select",""],["","00574220520","TRETINOIN","0.05%","20","Select","Select",""],["","65162044211","MECLIZINE","25MG","30","Select","Select",""],["","00093505898","ATORVASTATIN","40MG","90","Select","Select",""],["","45802046564","KETOCONAZOLE","2%","120","Select","Select",""],["","50111078751","AZITHROMYCIN","250MG","6","Select","Select",""],["","59310058020","PROAIR","","1","Select","Select",""],["","00054414622","CLOTRIMAZOLE","10MG","50","Select","Select",""],["","51672136504","FLUOCIN","0.01%","60","Select","Select",""],["","17478007035","ERYTHROMYCIN","5MG\/GM","4","Select","Select",""],["","17478071310","OFLOXACIN","0.3% OP","5","Select","Select",""],["","69543025216","VIRTUSSIN ","100-10\/5","120","Select","Select",""],["","59310058020","PROAIR ","","1","Select","Select",""],["","69452014430","BENZONATATE ","200MG","30","Select","Select",""],["","50111078751","AZITHROMYCIN ","250MG","6","Select","Select",""],["","00054414622","CLOTRIMAZOLE ","10MG","50","Select","Select",""],["","00143992701","CIPROFLOXACN ","250MG","14","Select","Select",""],["","42806031250","DOXYCYCL ","100MG","20","Select","Select",""],["","45802096126","CLOBETASOL ","0.05%","118","Select","Select",""],["","45802046564","KETOCONAZOLE ","2%","120","Select","Select",""],["","65162044211","MECLIZINE ","25MG","30","Select","Select",""],["","00093505898","ATORVASTATIN ","40MG","90","Select","Select",""],["","17478007035","ERYTHROMYCIN ","5MG\/GM","4","Select","Select",""],["","65162027250","SMZ\/TMP ","800-160","14","Select","Select",""],["","17478071310","OFLOXACIN ","0.3% OP","5","Select","Select",""],["","00574220520","TRETINOIN ","0.05%","20","Select","Select",""],["","51672136504","FLUOCIN ","0.01%","-60","Select","Select",""],["","51383000313","VASHE ","THERAPY","3000","Select","Select",""],["","61314063006","NEO\/POLY\/DEX ","0.1% OP","5","Select","Select",""],["","51383000313","VASHE","THERAPY","3000","Select","Select",""],["","61314063006","NEO\/POLY\/DEX","0.1% OP","5","Select","Select",""],["","70010077001","METHOCARBAM","750MG","90","Select","Select",""],["","42806040021","METHYLPRED","4MG","21","Select","Select",""],["","42806040021","METHYLPRED ","TAB 4MG","21","Select","Select",""],["","70010077001","METHOCARBAM ","TAB 750MG","90","Select","Select",""],["","67877021905","CEPHALEXIN ","CAP 500MG","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":""}]}]}