{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LINDSAY   P HUNEYCUTT","gend":1,"add":"1720 KINGS HWY","city":"SUFFOLK","state":"VA","zip":"23435-9998","dob":"1981-09-19","age":"","mstatus":"","insh":"2046658*02","cliId":"","pno":"757\/729-2453","cno":"757\/288-9797","email":"","ename":"","eno":"","pphy":"VANHORN, MARILYN MD","ppno":"757\/627-6220","pcpadd":"SUITE 100 400 W BRAMBLETON AVE","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23510,"pcpcounty":"","pcpid":111045,"pcpname":"Hague Medical Associates","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"757\/729-2453","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/627-0200","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["A49.9","R50.9","D89.9","L28.0","L82.1","L81.4","D18.00","J30.1","J30.89","T78.40XA","L50.0","L50.3","M32.9","Z87.891","Z91.011","Z91.018","L29.9","M79.7","E06.3","R21.","R41.3","R53.1","R53.83","E55.9","D51.9","M53.3","Z20.828","R05.","R41.840","E03.9","Z68.33","N30.01","R39.9","N39.0","N30.90"],"date":["2020-01-21","2020-01-21","2020-01-21","2021-05-03","2021-05-03","2021-05-03","2021-05-03","2020-02-27","2020-02-27","2020-03-14","2020-03-14","2020-03-14","2020-01-21","2020-03-14","2020-03-14","2020-03-14","2020-03-14","2020-08-18","2020-08-18","2020-03-25","2020-08-18","2020-08-18","2020-08-18","2020-08-18","2020-08-18","2020-02-28","2020-11-30","2021-04-24","2020-01-21","2020-08-10","2020-08-10","2021-07-11","2021-07-11","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":[["","00074929690","SYNTHROID","112MCG","90","Select","Select",""],["","49502010202","EPINEPHRINE","0.3MG","-2","Select","Select",""],["","00591544305","PREDNISONE","20MG","12","Select","Select",""],["","64380080707","IBUPROFEN","800MG","30","Select","Select",""],["","00172572860","FAMOTIDINE","20MG","60","Select","Select",""],["","43598081115","CETIRIZINE","10MG","180","Select","Select",""],["","42794001912","LIOTHYRONINE","25MCG","-45","Select","Select",""],["","16477034003","UREA","40%","85","Select","Select",""],["","00173068220","VENTOLIN","","18","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","00093317431","ALBUTEROL","HFA","8","Select","Select",""],["","00074929690","SYNTHROID ","112MCG","30","Select","Select",""],["","64380080707","IBUPROFEN ","800MG","30","Select","Select",""],["","42794001912","LIOTHYRONINE ","25MCG","45","Select","Select",""],["","00591544305","PREDNISONE ","20MG","12","Select","Select",""],["","00172572860","FAMOTIDINE ","20MG","28","Select","Select",""],["","49502010202","EPINEPHRINE ","0.3MG","2","Select","Select",""],["","43598081115","CETIRIZINE ","10MG","180","Select","Select",""],["","00173068220","VENTOLIN ","","18","Select","Select",""],["","44523061707","UREA ","40%","198","Select","Select",""],["","00093317431","ALBUTEROL ","HFA","8","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","65862042005","SMZ\/TMP ","800-160","14","Select","Select",""],["","65862042005","SMZ\/TMP","800-160","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":""}]}]}