{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" CAROL M CHUBB","gend":1,"add":"252 JAMES RIVER DR","city":"NEWPORT NEWS","state":"VA","zip":"23601-9998","dob":"1961-09-10","age":"","mstatus":"","insh":"2010311*02","cliId":"","pno":"757\/876-5671","cno":"757\/876-5671, ","email":"","ename":"","eno":"","pphy":"ELLIOTT, JOY DO","ppno":"757\/594-3800","pcpadd":"10510 JEFFERSON AVENUE STE A","pcpcity":"NEWPORT NEWS","pcpstate":"VA","pcpzip":"23601-9998","pcpcounty":"","pcpid":135802,"pcpname":"Riverside Brentwood Medical Center","plan":"OHP - OPTIMA","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":["D86.9","R06.09","Z79.51","M21.371","G56.01","Z12.31","R50.9","R53.83","M79.10","R53.1","D86.0","J30.9","G47.00","U07.1","F60.81","B34.9","R29.898","N94.89","C44.311","C44.301","M54.16","Z00.00","Z20.828","Z01.419","J44.9","N84.0","Z79.899","Z88.5","Z85.828","L90.5","D25.0","Z98.890","M51.36","M46.96","M46.97","M99.73","F41.1","R06.02","J84.9","R91.8","G61.82","Z01.812","Z20.822","Z48.1","Z80.41","F52.31","Z23.","Z01.818","J34.89","N85.8"],"date":["2021-03-30","2020-02-19","2020-02-19","2021-02-17","2020-04-03","2021-05-27","2020-06-11","2020-11-13","2020-06-11","2020-12-07","2021-02-17","2021-02-17","2021-02-17","2020-11-13","2020-12-23","2020-11-13","2021-03-02","2021-04-29","2020-02-25","2020-02-25","2020-03-11","2020-08-12","2020-11-13","2021-03-16","2021-04-29","2021-04-29","2021-04-29","2020-01-24","2020-02-25","2020-11-18","2021-04-29","2020-02-25","2020-03-25","2020-03-25","2020-03-25","2020-03-25","2020-12-08","2021-03-30","2021-03-30","2021-03-30","2021-03-30","2021-04-23","2021-04-23","2020-01-24","2021-03-16","2021-03-16","2021-04-02","2021-04-14","2020-01-24","2021-04-29"],"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":[["","67877021901","CEPHALEXIN","500MG","15","Select","Select",""],["","59310030480","QVAR","80MCG","11","Select","Select",""],["","16729013616","CLONAZEPAM","0.5MG","30","Select","Select",""],["","65862039010","ONDANSETRON","4MG ODT","20","Select","Select",""],["","31722094101","HYDROCO\/APAP","5-325MG","30","Select","Select",""],["","65162062710","TRAMADOL","50MG","12","Select","Select",""],["","00173085910","BREO","100-25","-60","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","31722072250","LEVOFLOXACIN","500MG","10","Select","Select",""],["","59746017306","PREDNISONE","10MG","30","Select","Select",""],["","00093101042","MUPIROCIN","2%","22","Select","Select",""],["","59762444002","METHYLPRED","4MG","21","Select","Select",""],["","58160088552","FLUARIX","2020-21","0","Select","Select",""],["","16729016801","ESCITALOPRAM","5MG","30","Select","Select",""],["","49502050002","EPIPEN","0.3MG","-2","Select","Select",""],["","49502010202","EPINEPHRINE","0.3MG","-2","Select","Select",""],["","13533080020","GAMUNEX-C","5GM\/50ML","100","Select","Select",""],["","00093317431","ALBUTEROL","HFA","26","Select","Select",""],["","42023015925","ADRENALIN","1MG\/ML","2","Select","Select",""],["","68982085002","OCTAGAM","5GM\/50ML","250","Select","Select",""],["","00944270004","GAMMAGARD","5GM\/50ML","100","Select","Select",""],["","68180035109","SERTRALINE","25MG","30","Select","Select",""],["","50383066730","LIDO\/PRILOCN","2.5-2.5%","-60","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":""}]}]}