{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LEIGH   ANNE WEST","gend":1,"add":"4567 LAKE HARBOR DR","city":"GLOUCESTER","state":"VA","zip":"23061-9998","dob":"1958-04-13","age":"","mstatus":"","insh":"2027100*21","cliId":"","pno":"804\/693-6959","cno":"804\/693-6959","email":"","ename":"","eno":"","pphy":"LEMING, JOSEPH A MD","ppno":"804\/693-3500","pcpadd":"6760 MAIN STREET","pcpcity":"GLOUCESTER","pcpstate":"VA","pcpzip":23061,"pcpcounty":"","pcpid":174665,"pcpname":"","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"757\/810-3556","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/693-3503","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["L82.0","L82.1","D23.9","L57.8","L81.4","Z83.71","K21.9","R13.12","Z12.31","M46.1","M53.3","G89.29","K52.89","Z23.","J06.9","M25.551","M75.111","M19.011","M75.41","M25.711","M65.811","K25.9","K44.9","M25.511","Z98.890","Z09.","Z00.00","F33.41","M75.101","I65.22","E55.9","E78.5","R73.01","Z13.9","Z01.818","I70.0","R94.5","Z90.49","I65.23","Z20.828","M54.16","J01.90","B96.89","J20.9","N64.89","F41.8","I65.21","J30.89","M85.9","Z12.39","H92.09","S46.091A","M25.611","B34.9","Z20.822","M47.26","M75.121","M75.01","T81.89XA","Z12.11","J32.0","R92.8","Z00.01","I65.8","J30.9","Q76.49","M25.571","S82.64XA","S89.301A","M79.18","G43.819","Z78.0","J45.20","D18.01","D22.9","M47.816","I73.9"],"date":["2020-10-27","2021-10-25","2020-10-27","2020-10-27","2021-10-25","2020-11-10","2021-11-15","2020-11-10","2020-11-13","2021-11-15","2021-11-15","2021-11-15","2021-04-07","2021-11-15","2021-04-07","2021-06-04","2020-01-30","2020-01-30","2020-05-08","2020-01-30","2020-01-30","2020-04-10","2020-11-10","2020-11-20","2020-08-24","2020-09-18","2020-11-30","2020-10-19","2020-08-24","2021-10-21","2021-05-28","2021-05-28","2021-05-28","2021-06-04","2020-05-08","2021-02-22","2021-06-04","2021-02-22","2021-10-21","2021-09-11","2021-11-10","2021-02-17","2021-02-17","2020-02-01","2020-11-20","2021-06-04","2021-06-04","2021-06-04","2021-06-04","2021-06-04","2021-06-04","2020-02-19","2020-04-29","2021-09-11","2021-02-17","2021-06-18","2020-01-30","2020-05-11","2020-05-11","2020-11-10","2020-11-11","2020-11-20","2020-12-04","2020-12-04","2020-12-04","2021-06-18","2021-09-10","2021-06-10","2021-06-11","2021-07-21","2021-11-15","2021-11-15","2021-11-15","2021-10-25","2021-10-25","2021-10-28","2021-10-21"],"priorHcc":["",null,"","",null,"",null,"","",null,null,null,"",null,"","","","","","","","","","","","","","","",null,"","","","","","","","",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":[["","50228018005","GABAPENTIN","300MG","270","Select","Select",""],["","31722071390","PANTOPRAZOLE","40MG","30","Select","Select",""],["","00002143611","EMGALITY","120MG\/ML","2","Select","Select",""],["","65862037401","ESCITALOPRAM","10MG","30","Select","Select",""],["","00591555501","PROPRANOLOL","20MG","90","Select","Select",""],["","00185061501","HYDROXYZ","50MG","60","Select","Select",""],["","47781062801","BUTAL\/APAP","50-325MG","30","Select","Select",""],["","31722063231","OSELTAMIVIR","75MG","10","Select","Select",""],["","69097012303","TOPIRAMATE","50MG","180","Select","Select",""],["","60505257909","ATORVASTATIN","20MG","90","Select","Select",""],["","65162062710","TRAMADOL","50MG","28","Select","Select",""],["","68382004101","PROMETHAZINE","25MG","20","Select","Select",""],["","88888888887","DMR","","1","Select","Select",""],["","65862062690","RIZATRIPTAN","10MG ODT","9","Select","Select",""],["","42858010201","OXYCOD\/APAP","5-325MG","40","Select","Select",""],["","00143924920","AMOX\/K","875-125","20","Select","Select",""],["","31722094101","HYDROCO\/APAP","5-325MG","28","Select","Select",""],["","69238110005","DOXYCYCL","100MG","20","Select","Select",""],["","68180031906","BUPROPN","150MG XL","90","Select","Select",""],["","16714007104","BACLOFEN","10MG","90","Select","Select",""],["","00173068220","VENTOLIN","","18","Select","Select",""],["","59746017310","PREDNISONE","10MG","-21","Select","Select",""],["","63304061650","DOXYCYC","100MG","20","Select","Select",""],["","00093317431","ALBUTEROL","HFA","8","Select","Select",""],["","72647033104","METHYLPRED","4MG","21","Select","Select",""],["","65162003310","APAP\/CODEINE","300-30MG","21","Select","Select",""],["","62332025118","AZITHROMYCIN","250MG","6","Select","Select",""],["","86876015488","","","1","Select","Select",""],["","00781543920","CEFPODOXIME","200MG","20","Select","Select",""],["","58160088552","FLUARIX","2020-21","0","Select","Select",""],["","00006483703","PNEUMOVAX","25\/0.5","0","Select","Select",""],["","69452014430","BENZONATATE","200MG","-20","Select","Select",""],["","00121077516","GG\/CODEINE","100-10\/5","-60","Select","Select",""],["","69543025116","VIRTUSSIN","100-10\/5","60","Select","Select",""],["","00002143611","EMGALITY ","120MG\/ML","2","Select","Select",""],["","31722071390","PANTOPRAZOLE ","40MG","30","Select","Select",""],["","50228018005","GABAPENTIN ","300MG","-270","Select","Select",""],["","60505257909","ATORVASTATIN ","20MG","90","Select","Select",""],["","69097012303","TOPIRAMATE ","50MG","180","Select","Select",""],["","47781062801","BUTAL\/APAP ","50-325MG","30","Select","Select",""],["","00591555501","PROPRANOLOL ","20MG","90","Select","Select",""],["","65862037401","ESCITALOPRAM ","10MG","30","Select","Select",""],["","00185061501","HYDROXYZ ","50MG","60","Select","Select",""],["","31722094101","HYDROCO\/APAP ","5-325MG","28","Select","Select",""],["","31722063231","OSELTAMIVIR ","75MG","10","Select","Select",""],["","00143924920","AMOX\/K ","875-125","20","Select","Select",""],["","42858010201","OXYCOD\/APAP ","5-325MG","30","Select","Select",""],["","00093317431","ALBUTEROL ","HFA","8","Select","Select",""],["","69238110005","DOXYCYCL ","100MG","20","Select","Select",""],["","68382004101","PROMETHAZINE ","25MG","20","Select","Select",""],["","69543013611","TRAMADOL ","50MG","28","Select","Select",""],["","00173068220","VENTOLIN ","","18","Select","Select",""],["","88888888887","DMR ","","1","Select","Select",""],["","68180031906","BUPROPN ","150MG XL","30","Select","Select",""],["","65862062690","RIZATRIPTAN ","10MG ODT","9","Select","Select",""],["","00781543920","CEFPODOXIME ","200MG","20","Select","Select",""],["","16714007104","BACLOFEN ","10MG","90","Select","Select",""],["","72647033104","METHYLPRED ","4MG","21","Select","Select",""],["","58160088552","FLUARIX ","2020-21","0","Select","Select",""],["","59746017310","PREDNISONE ","10MG","-21","Select","Select",""],["","00006483703","PNEUMOVAX ","25\/0.5","0","Select","Select",""],["","63304061650","DOXYCYC ","100MG","-20","Select","Select",""],["","69452014430","BENZONATATE ","200MG","-20","Select","Select",""],["","00121077516","GG\/CODEINE ","100-10\/5","-60","Select","Select",""],["","69543025116","VIRTUSSIN ","100-10\/5","60","Select","Select",""],["","62332025118","AZITHROMYCIN ","250MG","6","Select","Select",""],["","65162003310","APAP\/CODEINE ","300-30MG","21","Select","Select",""],["","59267100002","PFIZER ","COVID-19","0","Select","Select",""],["","59267100002","PFIZER","COVID-19","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","",""],["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":""}]}]}