{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CLAIBORNE BLONDIN","gend":0,"add":"7421 GLENEAGLES ROAD","city":"NORFOLK","state":"VA","zip":"23505-9998","dob":"1990-09-23","age":"","mstatus":"","insh":"2007642*01","cliId":"","pno":"401\/575-6681","cno":"401\/575-6681","email":"","ename":"","eno":"","pphy":"DESHMUKH, PRAVIN M MD","ppno":"757\/278-2240","pcpadd":"155 KINGSLEY LANE SUITE 400","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23505,"pcpcounty":"","pcpid":142722,"pcpname":"BON SECOURS SHORT PUMP PRIMARY CARE","plan":"OHP","program":"ACA","lob":"Individual","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/489-6469","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R05.","R59.9","R22.1","G44.201","Z20.828","J02.9","M26.602","R59.0","J31.2","R53.82","L30.9","L23.7","Z68.27","J35.1","J35.01","R13.10","R07.9","D22.9","R19.09","R59.1","S82.831A","Z01.89","Z13.29","J35.8","Z86.19","N50.812","N45.2","N45.3","Z01.818","N45.1","N50.819","N43.3"],"date":["2020-02-14","2020-02-14","2020-06-08","2021-03-24","2021-03-24","2021-03-24","2021-03-24","2021-04-08","2020-01-15","2020-01-15","2020-01-15","2020-01-22","2020-01-15","2020-02-27","2021-05-06","2020-02-27","2020-02-14","2020-08-18","2021-03-18","2021-04-08","2020-10-01","2021-03-15","2021-03-15","2021-05-06","2020-01-22","2021-11-13","2021-08-26","2021-08-26","2021-08-26","2021-09-02","2021-10-28","2021-11-13"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","",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":[["","68462079817","TRIAMCINOLON","0.50%","30","Select","Select",""],["","00394085932","HYDROCORT","1%","228","Select","Select",""],["","51224002230","AZITHROMYCIN","250MG","-6","Select","Select",""],["","00591505221","PREDNISONE","5MG","21","Select","Select",""],["","59746000103","METHYLPRED","4MG","21","Select","Select",""],["","52817033010","CYCLOBENZAPR","5MG","90","Select","Select",""],["","67877032105","IBUPROFEN","800MG","30","Select","Select",""],["","00406012405","HYDROCO\/APAP","7.5-325","56","Select","Select",""],["","00093314705","CEPHALEXIN","500MG","14","Select","Select",""],["","68462079817","TRIAMCINOLON ","0.50%","30","Select","Select",""],["","00394085932","HYDROCORT ","1%","228","Select","Select",""],["","00591505221","PREDNISONE ","5MG","-21","Select","Select",""],["","51224002230","AZITHROMYCIN ","250MG","6","Select","Select",""],["","59746000103","METHYLPRED ","4MG","21","Select","Select",""],["","52817033010","CYCLOBENZAPR ","5MG","90","Select","Select",""],["","67877032105","IBUPROFEN ","800MG","30","Select","Select",""],["","00093314705","CEPHALEXIN ","500MG","14","Select","Select",""],["","00406012405","HYDROCO\/APAP ","7.5-325","56","Select","Select",""],["","75834020101","OFLOXACIN ","400MG","-20","Select","Select",""],["","75834020150","OFLOXACIN","400MG","20","Select","Select",""],["","68462010530","ONDANSETRON","4MG","12","Select","Select",""],["","70010077001","METHOCARBAM","750MG","90","Select","Select",""],["","68462010530","ONDANSETRON ","TAB 4MG","12","Select","Select",""],["","70010077001","METHOCARBAM ","TAB 750MG","90","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":""}]}]}