{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JENNIFER   C WALK","gend":1,"add":"123 HEMPSTEAD ROAD","city":"WILLIAMSBURG","state":"VA","zip":"23188-9998","dob":"1978-08-13","age":"","mstatus":"","insh":"2036141*02","cliId":"","pno":"757\/592-6752","cno":"757\/592-6752","email":"","ename":"","eno":"","pphy":"MARCUSON, PATRICIA L MD","ppno":"757\/645-3150","pcpadd":"STE 400 400 SENTARA CIR","pcpcity":"WILLIAMSBURG","pcpstate":"VA","pcpzip":23188,"pcpcounty":"","pcpid":119566,"pcpname":"WILLIAMSBURG INTERNAL MEDICINE","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"757\/876-0607","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/645-3149","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["H10.13","D51.3","E55.9","E61.2","R53.83","Z20.822","N17.9","N13.30","N20.1","N12.","N28.1","R78.81","N28.9","B95.61","R10.11","F41.9","F33.41","R41.840","R10.9","A49.1","N13.2","D50.9","T37.0X5A","Z01.812","E78.5","Z00.00","R21.","J30.2","N39.0","R31.9","L82.0","L81.4","L57.8","Z71.9","K82.8","Z45.2","N20.2","Z95.828","L71.0","A49.01","R04.0","N13.6","R30.0","G47.00","N83.202","I95.9","R70.0","R79.82","E87.6","K82.9","Z90.49","Z82.49","R65.10","N20.0","Z96.0","L70.8","Z88.1","N20.9","Z79.899","Z87.442","Z88.2","Z86.19","N28.89","Z81.8","Z28.21","R63.4","E83.42","N10.","R50.9","N30.01","M54.6","Z98.890","Z90.89","R82.90","Z93.6","E83.59","N29.","B99.9","N83.201","R01.1"],"date":["2020-10-15","2021-05-17","2021-05-17","2021-05-17","2021-05-17","2021-06-24","2021-06-08","2021-11-17","2021-11-05","2021-11-20","2021-11-17","2021-06-30","2021-06-08","2021-06-30","2021-06-07","2021-10-20","2021-01-05","2021-01-05","2021-11-13","2021-06-30","2021-06-16","2021-07-29","2021-06-21","2021-06-22","2020-05-11","2020-05-11","2020-10-15","2020-10-15","2021-11-13","2021-11-13","2020-12-17","2020-12-17","2020-12-17","2021-07-16","2021-06-07","2021-06-07","2021-07-28","2021-06-02","2020-10-30","2021-06-04","2021-05-24","2021-10-20","2021-06-16","2021-10-20","2021-10-20","2021-06-01","2021-06-01","2021-06-30","2021-11-20","2021-06-01","2021-10-20","2021-10-20","2021-07-03","2021-11-20","2021-11-16","2021-07-16","2021-06-22","2021-06-16","2021-11-16","2021-06-24","2021-11-16","2021-11-16","2021-11-09","2021-10-20","2021-10-20","2021-11-20","2021-11-20","2021-10-22","2021-10-20","2021-11-13","2021-11-16","2021-11-16","2021-11-16","2021-11-16","2021-11-20","2021-10-19","2021-10-19","2021-11-09","2021-11-09","2021-11-19"],"priorHcc":["","","","","","","",null,null,null,null,"","","","",null,"","",null,"","","","","","","","","",null,null,"","","","","","","","","","","",null,"",null,null,"","","",null,"",null,null,"",null,null,"","","",null,"",null,null,null,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":[["","68382080701","TRAZODONE","150MG","30","Select","Select",""],["","16714070301","LAMOTRIGINE","200MG","-180","Select","Select",""],["","00093768432","OLOPATADINE","0.20%","2","Select","Select",""],["","43547028810","BUPROPION","100MG SR","60","Select","Select",""],["","00093310953","AMOXICILLIN","500MG","21","Select","Select",""],["","68382078201","DOXYCYC","50MG","30","Select","Select",""],["","54092038301","ADDERALL","10MG","-30","Select","Select",""],["","17478071710","KETOTIF","0.025%OP","-5","Select","Select",""],["","00228305911","AMPHET\/DEXTR","10MG ER","30","Select","Select",""],["","59417010310","VYVANSE","30MG","30","Select","Select",""],["","00904759080","FEROSUL","325MG","30","Select","Select",""],["","65862039010","ONDANSETRON","4MG ODT","-12","Select","Select",""],["","00406012301","HYDROCO\/APAP","5-325MG","18","Select","Select",""],["","49281042050","FLUZONE","2020-21","0","Select","Select",""],["","08290236850","LACTINEX","","360","Select","Select",""],["","65862042001","SMZ\/TMP","800-160","14","Select","Select",""],["","68382080701","TRAZODONE ","150MG","30","Select","Select",""],["","00093310953","AMOXICILLIN ","500MG","21","Select","Select",""],["","43547028810","BUPROPION ","100MG SR","60","Select","Select",""],["","62332050105","OLOPATADINE ","0.10%","5","Select","Select",""],["","16714070301","LAMOTRIGINE ","200MG","180","Select","Select",""],["","17478071710","KETOTIF ","0.025%OP","5","Select","Select",""],["","49281042050","FLUZONE ","2020-21","0","Select","Select",""],["","68382078201","DOXYCYC ","50MG","30","Select","Select",""],["","54092038301","ADDERALL ","10MG","-30","Select","Select",""],["","59417010310","VYVANSE ","30MG","30","Select","Select",""],["","00228305911","AMPHET\/DEXTR ","10MG ER","30","Select","Select",""],["","65862042001","SMZ\/TMP ","800-160","14","Select","Select",""],["","65862039010","ONDANSETRON ","4MG ODT","-12","Select","Select",""],["","00904759080","FEROSUL ","325MG","30","Select","Select",""],["","08290236850","LACTINEX ","","360","Select","Select",""],["","00406012301","HYDROCO\/APAP ","5-325MG","18","Select","Select",""],["","65862059801","TAMSULOSIN ","0.4MG","30","Select","Select",""],["","67877021901","CEPHALEXIN ","500MG","10","Select","Select",""],["","59267100002","PFIZER ","COVID-19","0","Select","Select",""],["","67877021901","CEPHALEXIN","500MG","10","Select","Select",""],["","65862059801","TAMSULOSIN","0.4MG","30","Select","Select",""],["","59267100002","PFIZER","COVID-19","0","Select","Select",""],["","45802075930","PROMETHAZINE","25MG","12","Select","Select",""],["","55111012701","CIPROFLOXACN","500MG","12","Select","Select",""],["","67877054360","CEFDINIR","300MG","28","Select","Select",""],["","59746011306","PROCHLORPER","5MG","20","Select","Select",""],["","45802075930","PROMETHAZINE ","SUP 25MG","12","Select","Select",""],["","55111012701","CIPROFLOXACN ","TAB 500MG","10","Select","Select",""],["","59746011306","PROCHLORPER ","TAB 5MG","20","Select","Select",""],["","67877054360","CEFDINIR ","CAP 300MG","28","Select","Select",""],["","00406324301","HYDROMORPHON ","TAB 2MG","18","Select","Select",""],["","00143924920","AMOX\/K ","TAB 875-125","20","Select","Select",""],["","04142000024","FLORASTOR ","CAP 250MG","20","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":""}]}]}