{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ALEK   A PANTELIDES","gend":0,"add":"7 TIDES CT","city":"PORTSMOUTH","state":"VA","zip":"23703-9998","dob":"1992-04-13","age":"","mstatus":"","insh":"2041980*01","cliId":"","pno":"757\/493-1464","cno":"757\/493-1464","email":"","ename":"","eno":"","pphy":"SONI, PARIMAL J MD","ppno":"757\/483-3560","pcpadd":"SUITE E 3802 POPULAR HILL RD","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":23321,"pcpcounty":"","pcpid":113361,"pcpname":"","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"757\/483-1204","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/483-4239","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N43.3","D56.9","D64.9","Z00.00","J45.998","Z23.","M54.2","M54.6","M54.5","M48.04","M51.34","Z01.812","Z20.822","N50.89","Q55.29","F17.210","Z79.899","Z88.6","E55.9","G89.29","L70.9","Z71.9","L73.0","L73.8","E78.5","H81.13"],"date":["2021-06-18","2021-09-23","2021-09-23","2021-05-03","2021-09-23","2021-04-22","2021-05-17","2021-02-25","2021-09-23","2021-05-17","2021-05-17","2021-06-04","2021-06-04","2021-06-07","2021-06-07","2021-06-07","2021-07-26","2021-06-07","2021-03-22","2021-05-17","2021-07-26","2021-07-26","2021-01-07","2021-01-07","2021-09-16","2021-11-18"],"priorHcc":["",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":[["","69238110005","DOXYCYCL","100MG","60","Select","Select",""],["","00406012301","HYDROCO\/APAP","5-325MG","10","Select","Select",""],["","21922000201","CLINDAMYCIN","1%","60","Select","Select",""],["","45802028034","BENZOYL","5% WASH","227","Select","Select",""],["","00054001720","PREDNISONE","10MG","20","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","51672139409","TRETINOIN","0.05%","45","Select","Select",""],["","42858010201","OXYCOD\/APAP","5-325MG","8","Select","Select",""],["","70677003402","STOOL","100MG","14","Select","Select",""],["","59746021110","CYCLOBENZAPR","5MG","30","Select","Select",""],["","00093317431","ALBUTEROL","HFA","8","Select","Select",""],["","51672139409","TRETINOIN ","0.05%","45","Select","Select",""],["","69238110005","DOXYCYCL ","100MG","60","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","59746021110","CYCLOBENZAPR ","5MG","30","Select","Select",""],["","00093317431","ALBUTEROL ","HFA","8","Select","Select",""],["","21922000201","CLINDAMYCIN ","1%","60","Select","Select",""],["","45802028034","BENZOYL ","5% WASH","227","Select","Select",""],["","70677003402","STOOL ","100MG","14","Select","Select",""],["","00054001720","PREDNISONE ","10MG","20","Select","Select",""],["","00406012301","HYDROCO\/APAP ","5-325MG","10","Select","Select",""],["","55111013781","ZENATANE ","40MG","60","Select","Select",""],["","10631000731","ABSORICA ","32MG","60","Select","Select",""],["","42858010201","OXYCOD\/APAP ","5-325MG","8","Select","Select",""],["","55111013781","ZENATANE","40MG","60","Select","Select",""],["","00186037020","SYMBICORT","160-4.5","10","Select","Select",""],["","10631000731","ABSORICA","32MG","60","Select","Select",""],["","00310737020","BUDES\/FORMOT","160-4.5","10","Select","Select",""],["","00186037020","SYMBICORT ","AER 160-4.5","10","Select","Select",""],["","00310461612","BREZTRI ","AER SPHERE","32","Select","Select",""],["","76204010025","IPRATROPIUM ","SOL 0.02%INH","-438","Select","Select",""],["","00536136223","NICOTINE ","GUM 2MG","220","Select","Select",""],["","16714047801","AMOX\/K ","TAB 875-125","20","Select","Select",""],["","00536129910","MECLIZINE ","CHW 25MG","20","Select","Select",""],["","59762219803","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","00310737020","BUDES\/FORMOT ","AER 160-4.5","10","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":""}]}]}