{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"REBECCA   A TEMPLON","gend":1,"add":"303 W SPRING AVE","city":"ELKTON","state":"VA","zip":"22827-9998","dob":"1978-12-30","pno":"540\/578-0144","cno":"540\/578-0144","email":"","pphy":"CAMPBELL, AMY MD","ppno":"","pcpadd":"9 MANHATTAN SQUARE STE A","pcpcity":"HAMPTON","pcpstate":"VA","pcpzip":23666,"pcpcounty":"","pcpid":410067,"pcpname":"Hampton Family Practice, PLLC","insh":"2020731*01","cliId":"","plan":"OHP","program":"ACA","lob":"Individual","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/838-0612","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I49.3","R06.02","R00.2","B99.9","K52.9","R10.9","K62.89","U07.1","R05.","J18.9","L82.1","L72.0","D48.5","Z92.25","M79.672","S92.355D","I73.00","I49.1","R42.","B07.8","B35.1","K60.2","K21.9","D80.2","D80.4","B34.9","Z20.828","E03.9","H04.123","H57.11","N20.0","K63.89","N23.","L21.8","L60.8","L53.8","M35.9","M35.00","M89.49","M70.61","M79.7","M81.0","E55.9","Z51.81","M70.62","R07.2","R51.9","J02.9","J34.89","R68.83","Z01.419","M79.675","M25.475","R26.2","D80.1","L90.9","M77.42","I49.8","R07.89","J01.90","K59.00","J84.10","R10.84","R22.1","R94.39","Z82.3","J04.0","M35.01","Z86.16","Z85.828","Z79.899","Z88.6","Z88.1","Z91.011","Z88.5","Z88.0","Z91.013","Z88.8","Z91.018","Z91.09","N89.8","Z78.0","Z12.31","Z82.62","Z79.83","Z92.241","E04.1","S92.355A","G89.29","M89.8X7","Z23.","D72.810","Z79.52","M25.872","Z20.822","R09.81"],"date":["2020-07-13","2021-02-12","2020-06-30","2020-11-10","2020-10-06","2020-10-06","2020-10-06","2021-11-06","2021-02-12","2021-02-12","2021-04-02","2021-04-02","2021-04-02","2021-04-02","2021-09-09","2021-09-09","2021-08-19","2020-07-13","2020-07-13","2020-08-14","2020-08-14","2020-11-10","2020-11-10","2020-11-10","2020-11-10","2020-12-09","2021-02-01","2021-08-19","2021-01-25","2021-01-25","2021-01-29","2021-01-29","2021-01-29","2020-01-15","2020-01-15","2020-01-15","2021-08-19","2021-08-19","2021-08-19","2021-08-19","2021-08-19","2021-08-19","2021-08-19","2021-08-19","2021-08-19","2020-06-16","2021-11-06","2021-02-05","2021-02-05","2021-02-05","2021-04-02","2021-06-11","2021-09-09","2021-09-09","2021-08-19","2021-09-09","2021-09-09","2020-06-11","2020-06-11","2021-02-11","2021-02-23","2021-02-23","2021-02-23","2021-05-20","2020-06-30","2020-06-30","2020-12-07","2021-02-23","2021-02-23","2021-02-23","2021-02-23","2021-02-23","2021-02-23","2021-02-23","2021-02-23","2021-02-23","2021-02-23","2021-02-23","2021-02-23","2021-02-23","2020-02-21","2020-08-12","2021-11-19","2020-10-30","2020-10-30","2020-10-30","2021-05-20","2021-06-24","2021-08-06","2021-08-21","2021-04-29","2020-09-30","2020-09-30","2021-08-21","2021-11-06","2021-11-06"],"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":[["","00378180510","LEVOTHYROXIN","75MCG","30","Select","Select",""],["","60219107601","AZATHIOPRINE","50MG","30","Select","Select",""],["","51991081801","PROPRANOLOL","80MG ER","30","Select","Select",""],["","49884005401","IMIPRAM","10MG","-180","Select","Select",""],["","00115168974","BUDESONIDE","0.5MG\/2","120","Select","Select",""],["","00115703301","FLUDROCORT","0.1MG","90","Select","Select",""],["","45802014167","CICLOPIROX","8%","7","Select","Select",""],["","33332032001","AFLURIA","2020-21","0","Select","Select",""],["","57237016190","OMEPRAZOLE","20MG","180","Select","Select",""],["","0","","","25","Select","Select",""],["","24208029505","TOBRA\/DEXAME","0.3-0.1%","5","Select","Select",""],["","57237005920","CEFUROXIME","500MG","14","Select","Select",""],["","49281072010","FLUBLOK","2020-21","0","Select","Select",""],["","68180016013","AZITHROMYCIN","250MG","6","Select","Select",""],["","00378064205","PREDNISONE","20MG","14","Select","Select",""],["","42799080601","IVERMECTIN","3MG","9","Select","Select",""],["","70461032103","FLUCLVX","2021-22","0","Select","Select",""],["","00093598627","EPINEPHRINE","0.3MG","2","Select","Select",""],["","00378180510","LEVOTHYROXIN ","TAB 75MCG","30","Select","Select",""],["","00115166003","PROPRANOLOL ","TAB 20MG","60","Select","Select",""],["","60219107601","AZATHIOPRINE ","TAB 50MG","30","Select","Select",""],["","49884005401","IMIPRAM ","TAB 10MG","-180","Select","Select",""],["","00115703301","FLUDROCORT ","TAB 0.1MG","90","Select","Select",""],["","00115168974","BUDESONIDE ","SUS 0.5MG\/2","120","Select","Select",""],["","45802014167","CICLOPIROX ","SOL 0.08","7","Select","Select",""],["","33332032001","AFLURIA ","INJ 2020-21","0","Select","Select",""],["","57237016190","OMEPRAZOLE ","CAP 20MG","180","Select","Select",""],["","57237005920","CEFUROXIME ","TAB 500MG","14","Select","Select",""],["","49281072010","FLUBLOK ","INJ 2020-21","0","Select","Select",""],["","00378064205","PREDNISONE ","TAB 20MG","14","Select","Select",""],["","68180016013","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","42799080601","IVERMECTIN ","TAB 3MG","9","Select","Select",""],["","24208029505","TOBRA\/DEXAME ","SUS 0.3-0.1%","5","Select","Select",""],["","00093598627","EPINEPHRINE ","INJ 0.3MG","2","Select","Select",""],["","70461032103","FLUCLVX ","INJ 2021-22","0","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":""}]}]}