{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KELLY   JO ZIMPEL","gend":1,"add":"209 SIGNAL QUAY","city":"CHESAPEAKE","state":"VA","zip":"23320-9998","dob":"1960-01-10","age":"","mstatus":"","insh":"2055882*01","cliId":"","pno":"757\/581-0123","cno":"757\/581-0123","email":"","ename":"","eno":"","pphy":"GAGLIONE, MARGARET M MD","ppno":"757\/644-6819","pcpadd":"1405 KEMPSVILLE ROAD","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":23320,"pcpcounty":"","pcpid":178852,"pcpname":"COASTAL INTERNAL MEDICINE AND TIDEWATER BARIATRICS","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"757\/382-9212","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/644-6816","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E06.3","E55.9","M51.37","M67.02","M19.072","S93.412A","G89.18","R60.0","M79.89","T81.31XA","E03.9","Z20.828","Z96.651","Z79.82","Z98.1","Z79.890","Z79.52","Z91.018","Z87.891","Z88.5","Z91.030","Z82.49","Z83.3","Z80.0","Z82.0","Z83.49","E04.2","C73.","E89.0","Z11.0","Z13.220","D48.5","S01.85XA","W54.0XXA","Z91.02","R51.9","Z47.1","M19.90","G47.30","Q04.8","Z91.81","W19.XXXA","S93.412D","T84.213A","J06.9","R05.","M17.11","Z01.818","Z23.","Z01.419","J30.1","E66.9","Z79.899","Z90.710","Z68.35","I87.392","Q82.0","M25.572","Z12.31","I83.892","I83.812","I87.2","M17.12","M25.561","R73.9","Z09.","Z01.810","Z01.812","R94.31","Z78.0","N39.3","Z80.3"],"date":["2021-05-13","2021-03-22","2020-01-02","2020-01-13","2020-01-13","2020-01-13","2020-12-01","2020-05-26","2020-07-16","2020-12-17","2020-12-17","2020-12-17","2021-03-24","2020-12-17","2020-12-17","2020-12-17","2020-12-17","2020-12-17","2020-12-17","2020-12-17","2020-12-17","2020-12-17","2020-12-17","2020-12-17","2020-12-17","2020-12-17","2021-05-13","2020-04-02","2020-04-02","2020-09-14","2020-09-14","2020-10-14","2020-11-27","2020-11-27","2020-11-30","2020-11-27","2020-12-02","2020-12-02","2020-12-02","2020-12-02","2020-12-02","2020-12-17","2020-01-13","2020-08-03","2020-08-10","2020-08-10","2020-12-01","2020-11-27","2021-04-19","2021-10-21","2020-11-30","2020-11-30","2020-11-30","2020-11-30","2020-11-30","2020-04-28","2020-07-16","2020-05-04","2021-11-11","2020-07-16","2020-05-21","2020-07-16","2020-10-14","2020-10-14","2021-03-22","2020-05-26","2020-11-05","2020-11-05","2020-11-05","2020-11-11","2021-11-10","2021-11-11"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",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":[["","00527133850","DOXYCYC","100MG","14","Select","Select",""],["","00781715683","ESTRADIOL","0.075MG","24","Select","Select",""],["","00093005805","TRAMADOL","50MG","6","Select","Select",""],["","42858010201","OXYCOD\/APAP","5-325MG","60","Select","Select",""],["","68462010530","ONDANSETRON","4MG","30","Select","Select",""],["","65162099508","DOTTI","0.075MG","24","Select","Select",""],["","69238183707","LEVOTHYROXIN","137MCG","90","Select","Select",""],["","68180012202","CEPHALEXIN","500MG","-2","Select","Select",""],["","69097015907","MELOXICAM","15MG","30","Select","Select",""],["","42858000101","OXYCODONE","5MG","42","Select","Select",""],["","72647033104","METHYLPRED","4MG","21","Select","Select",""],["","70461032003","FLUCLVX","2020-21","0","Select","Select",""],["","00143924920","AMOX\/K","875-125","20","Select","Select",""],["","49348098023","SM","81MG EC","120","Select","Select",""],["","00093226301","AMOXICILLIN","500MG","4","Select","Select",""],["","42858010201","OXYCOD\/APAP ","5-325MG","60","Select","Select",""],["","68462010530","ONDANSETRON ","4MG","30","Select","Select",""],["","00527133850","DOXYCYC ","100MG","14","Select","Select",""],["","69238183707","LEVOTHYROXIN ","137MCG","90","Select","Select",""],["","00781715683","ESTRADIOL ","0.075MG","24","Select","Select",""],["","69097015907","MELOXICAM ","15MG","30","Select","Select",""],["","00093005805","TRAMADOL ","50MG","28","Select","Select",""],["","68180012202","CEPHALEXIN ","500MG","-2","Select","Select",""],["","65162099508","DOTTI ","0.075MG","24","Select","Select",""],["","70461032003","FLUCLVX ","2020-21","0","Select","Select",""],["","42858000101","OXYCODONE ","5MG","42","Select","Select",""],["","00143924920","AMOX\/K ","875-125","20","Select","Select",""],["","49348098023","SM ","81MG EC","120","Select","Select",""],["","00093226301","AMOXICILLIN ","500MG","4","Select","Select",""],["","72647033104","METHYLPRED ","4MG","21","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":[[["Yes","Select","","","","","Select","",""],["Yes","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":""}]}]}