{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"EMILY RAPOPORT","gend":1,"add":"5529 GENTRY LN","city":"WILLIAMSBURG","state":"VA","zip":"23188-9998","dob":"1987-05-31","age":"","mstatus":"","insh":"2021067*01","cliId":"","pno":"757\/293-8653","cno":"757\/293-8653","email":"","ename":"","eno":"","pphy":"JAEGER, MATTHEW J MD","ppno":"757\/941-6400","pcpadd":"5483 MOORETOWN ROAD","pcpcity":"WILLIAMSBURG","pcpstate":"VA","pcpzip":23188,"pcpcounty":"","pcpid":196045,"pcpname":"","plan":"OHP","program":"ACA","lob":"Individual","region":"TIDEWATER","aligned":"","ano":"757\/784-2258","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":["F33.1","R87.810","Z32.02","E27.0","Z79.899","Z12.4","Z11.51","M20.11","G57.61","M79.671","R87.619","F32.9","Z01.419","Z30.09","Z12.39","F50.00","F50.01","Z00.00"],"date":["2020-06-10","2020-11-09","2020-11-09","2020-11-24","2020-10-06","2020-10-16","2020-10-16","2020-04-13","2020-04-13","2020-03-23","2020-11-09","2020-03-31","2020-10-16","2020-10-16","2020-10-16","2021-03-09","2021-10-01","2021-10-01"],"priorHcc":["","","","","","","","","","","","","","","","",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":[["","60758067090","DAPSONE","5%","90","Select","Select",""],["","53746051401","SPIRONOLACT","50MG","30","Select","Select",""],["","57237007710","ONDANSETRON","4MG ODT","30","Select","Select",""],["","62037072601","METHYLPHENID","36MG ER","30","Select","Select",""],["","00228202796","ALPRAZOLAM","0.25MG","90","Select","Select",""],["","65162010250","GABAPENTIN","300MG","60","Select","Select",""],["","68180031909","BUPROPN","150MG XL","30","Select","Select",""],["","50111043302","TRAZODONE","50MG","15","Select","Select",""],["","67857080804","SERNIVO","","120","Select","Select",""],["","50458022115","NIZORAL","2%","15","Select","Select",""],["","63402030830","LATUDA","80MG","-5","Select","Select",""],["","16571020150","DICLOFENAC","75MG DR","60","Select","Select",""],["","62541020330","QSYMIA","11.25-69","30","Select","Select",""],["","45802046564","KETOCONAZOLE","2%","120","Select","Select",""],["","00023520660","ACZONE","7.50%","60","Select","Select",""],["","70700011585","SYEDA","3-0.03MG","84","Select","Select",""],["","13107010501","PHENTERMINE","15MG","30","Select","Select",""],["","49281042050","FLUZONE","2020-21","0","Select","Select",""],["","45802040109","CICLOPIROX","1%","-240","Select","Select",""],["","65162055610","TEMAZEPAM","15MG","60","Select","Select",""],["","00009002901","XANAX","0.25MG","90","Select","Select",""],["","59148003713","REXULTI","1MG","15","Select","Select",""],["","64597030160","NUEDEXTA","20-10MG","60","Select","Select",""],["","68462025401","ROPINIROLE","0.5MG","30","Select","Select",""],["","57664068818","AMITRIPTYLIN","25MG","30","Select","Select",""],["","00187000520","ALTRENO","0.05%","20","Select","Select",""],["","51672138603","FLUOCINONIDE","0.05%","60","Select","Select",""],["","80777027399","MODERNA","COVID-19","0","Select","Select",""],["","00168026415","ALCLOMETASON","0.05%","15","Select","Select",""],["","51672404301","CLORAZ","7.5MG","30","Select","Select",""],["","50458058701","CONCERTA","54MG","30","Select","Select",""],["","53489012002","DOXYCYCL","100MG","14","Select","Select",""],["","57237000630","FLUCONAZOLE","200MG","14","Select","Select",""],["","31722094531","DROSPIR\/ETHI","3-0.03MG","84","Select","Select",""],["","68791010204","DERMA-SMOOTH","\/FS SCLP","118","Select","Select",""],["","51672530708","DAPSONE ","7.50%","90","Select","Select",""],["","53746051501","SPIRONOLACT ","100MG","90","Select","Select",""],["","67857080804","SERNIVO ","","120","Select","Select",""],["","00228202796","ALPRAZOLAM ","0.25MG","90","Select","Select",""],["","50111043302","TRAZODONE ","50MG","15","Select","Select",""],["","00023520660","ACZONE ","7.50%","60","Select","Select",""],["","50458022115","NIZORAL ","2%","15","Select","Select",""],["","57237007710","ONDANSETRON ","4MG ODT","30","Select","Select",""],["","63402030830","LATUDA ","80MG","30","Select","Select",""],["","62037072601","METHYLPHENID ","36MG ER","30","Select","Select",""],["","45802046564","KETOCONAZOLE ","2%","120","Select","Select",""],["","68180032002","BUPROPN ","300MG XL","30","Select","Select",""],["","65162010250","GABAPENTIN ","300MG","60","Select","Select",""],["","70700011585","SYEDA ","3-0.03MG","84","Select","Select",""],["","16571020150","DICLOFENAC ","75MG DR","-60","Select","Select",""],["","13107010501","PHENTERMINE ","15MG","30","Select","Select",""],["","51672138603","FLUOCINONIDE ","0.05%","60","Select","Select",""],["","62541020330","QSYMIA ","11.25-69","30","Select","Select",""],["","00168026415","ALCLOMETASON ","0.05%","15","Select","Select",""],["","00009002901","XANAX ","0.25MG","90","Select","Select",""],["","51672404301","CLORAZ ","7.5MG","30","Select","Select",""],["","49281042050","FLUZONE ","2020-21","0","Select","Select",""],["","64597030160","NUEDEXTA ","20-10MG","60","Select","Select",""],["","57237000630","FLUCONAZOLE ","200MG","14","Select","Select",""],["","45802040109","CICLOPIROX ","1%","120","Select","Select",""],["","53489012002","DOXYCYCL ","100MG","14","Select","Select",""],["","68462025401","ROPINIROLE ","0.5MG","30","Select","Select",""],["","70710122600","AMITRIPTYLIN ","25MG","30","Select","Select",""],["","65162055610","TEMAZEPAM ","15MG","60","Select","Select",""],["","68791010204","DERMA-SMOOTH ","\/FS SCLP","118","Select","Select",""],["","80777027399","MODERNA ","COVID-19","0","Select","Select",""],["","59148003713","REXULTI ","1MG","15","Select","Select",""],["","50458058701","CONCERTA ","54MG","30","Select","Select",""],["","31722094531","DROSPIR\/ETHI ","3-0.03MG","-84","Select","Select",""],["","00187000520","ALTRENO ","0.05%","20","Select","Select",""],["","00378110101","PRAZOSIN ","1MG","30","Select","Select",""],["","00378110101","PRAZOSIN","1MG","30","Select","Select",""],["","13913000519","GRALISE","600MG","21","Select","Select",""],["","19515081852","FLULAVAL","2021-22","0","Select","Select",""],["","13913000519","GRALISE ","TAB 600MG","21","Select","Select",""],["","19515081852","FLULAVAL ","INJ 2021-22","0","Select","Select",""],["","69238207707","PROPRANOLOL ","TAB 10MG","7","Select","Select",""],["","00143992801","CIPROFLOXACN ","TAB 500MG","14","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":""}]}]}