{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"THOMAS   E HAWTHORNE JR","gend":0,"add":"2100 KANTURK CT","city":"VIRGINIA BEACH","state":"VA","zip":"23456-9998","dob":"1961-09-05","age":"","mstatus":"","insh":"2079650*01","cliId":"","pno":"757\/353-5286","cno":"757\/353-5286","email":"","ename":"","eno":"","pphy":"SALSANO, ALESSIO C MD","ppno":"757\/495-4353","pcpadd":"5265 PROVIDENCE RD STE 401","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23464,"pcpcounty":"","pcpid":210630,"pcpname":"","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M85.80","M81.0","C79.51","Z51.0","C61.","E55.9","R55.","R79.89","W19.XXXA","S82.831D","S92.301D","K21.9","E83.52","R57.8","Z51.5","Z66.","G93.41","E87.2","N17.9","D62.","E87.0","E44.0","C78.7","A04.72","M84.48XA","E86.0","G51.0","M48.061","R07.9","R79.1","R53.1","R59.0","R41.82","Z85.46","M25.511","M25.512","R45.1","Z71.89","G89.3","C79.9","D64.9","C34.01","I48.0","I47.1","Z92.3","R00.0","M89.8X9","M79.2","R11.0","R53.0","I10.","R53.81","S82.831A","S93.324D","R42.","W19.XXXD","M54.5","M62.81","R26.2","S92.901A","S82.441A","M19.071","S93.431A","S93.321A","S92.341A","R04.0","Z45.2","I51.9","R06.02","R61.","R40.4","I82.409","M79.671","T14.90XA","S93.324A","G89.18","C79.52","Z85.820","S82.441D","R82.998","S82.401D","Z98.1","S82.409A","E83.51","R16.0","S92.201D","T78.40XA","F17.210","I35.1","S82.839A","R29.890","Z79.899","D84.9","E66.3","D07.5","A04.71","C7A.1","G93.40","S92.311A","S92.321A","Z20.822","D63.0","Z68.28","Z01.812","Z47.89","K59.00","R29.818","R41.0","Z98.890","R65.10","Z00.00","G89.29","M85.852","M85.851","M54.12","S92.221A","R29.898","Z72.0","Z71.6","D69.6","R13.10","R63.3","U07.1","M54.2","M25.561","R63.8","E46.","K94.23","D61.810","E43.","J18.9","E87.1","D61.818","T85.598A","C80.1","C7A.8","D61.9","F32.9","R62.7","C7B.8","Z85.830","J90.","M54.6","R26.89","S82.401A","K94.20","R94.5","Z93.1","E83.42","C34.02","R65.20","A41.9","J96.00","R18.8","B37.0","K22.2","R91.8","J98.4","K63.89","J98.11","M79.604","S22.43XA","D63.8","R07.81","R69.","Z74.01","D72.829"],"date":["2020-03-05","2020-03-05","2021-08-01","2021-04-05","2021-08-01","2021-05-22","2021-06-02","2021-04-12","2021-04-12","2021-05-27","2021-04-27","2021-07-25","2021-07-01","2021-05-24","2021-06-25","2021-07-24","2021-05-12","2021-06-20","2021-05-31","2021-05-12","2021-05-12","2021-05-12","2021-07-31","2021-07-24","2021-05-17","2021-05-21","2021-05-14","2021-05-17","2021-06-14","2021-05-17","2021-06-28","2021-05-17","2021-07-14","2021-06-20","2021-07-23","2021-05-17","2021-05-21","2021-05-21","2021-07-11","2021-07-13","2021-07-15","2021-06-04","2021-06-03","2021-07-25","2021-06-03","2021-07-26","2021-06-25","2021-06-25","2021-06-25","2021-06-25","2021-07-24","2021-07-16","2021-04-15","2021-07-20","2021-04-12","2021-04-16","2021-07-21","2021-07-01","2021-04-16","2021-04-14","2021-04-15","2021-07-20","2021-04-15","2021-04-15","2021-04-15","2021-05-18","2021-05-28","2021-06-17","2021-08-01","2020-11-17","2020-11-17","2021-04-07","2021-04-07","2021-04-07","2021-04-15","2021-04-16","2021-05-11","2021-05-11","2021-07-20","2020-12-01","2021-04-15","2021-04-15","2021-04-30","2021-07-01","2021-05-20","2021-05-27","2020-11-17","2021-04-06","2021-04-08","2021-04-12","2021-04-10","2021-06-21","2021-04-12","2021-04-12","2021-05-22","2021-06-03","2021-08-01","2021-06-21","2021-04-06","2021-04-06","2021-07-24","2021-05-22","2021-04-06","2021-04-13","2021-04-16","2021-07-21","2021-04-29","2021-05-19","2021-05-17","2021-06-19","2020-07-14","2021-05-13","2020-03-05","2020-03-05","2020-09-22","2021-04-06","2021-07-25","2021-04-15","2021-04-15","2021-08-01","2021-07-26","2021-06-04","2021-06-04","2021-07-11","2021-07-23","2021-07-30","2021-08-01","2021-07-30","2021-07-05","2021-07-24","2021-07-24","2021-05-22","2021-05-22","2021-07-29","2021-07-31","2021-07-25","2021-07-25","2021-07-25","2021-07-25","2021-07-24","2021-06-20","2021-08-01","2021-07-09","2021-07-16","2021-07-21","2021-07-24","2021-05-21","2021-07-26","2021-07-01","2021-07-15","2021-07-24","2021-07-24","2021-07-24","2021-07-31","2021-07-24","2021-07-26","2021-08-01","2021-07-28","2021-07-31","2021-08-01","2021-04-14","2021-07-30","2021-08-01","2021-04-19","2021-06-28","2021-06-28","2021-07-26"],"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":[["","00832105410","BACLOFEN","10MG","30","Select","Select",""],["","00054418425","DEXAMETHASON","4MG","-60","Select","Select",""],["","68180098103","LISINOPRIL","20MG","90","Select","Select",""],["","00469012599","XTANDI","40MG","-120","Select","Select",""],["","59746000103","METHYLPRED","4MG","21","Select","Select",""],["","59746011306","PROCHLORPER","5MG","-60","Select","Select",""],["","00093031401","KETOROLAC","10MG","20","Select","Select",""],["","69097094312","GABAPENTIN","300MG","180","Select","Select",""],["","16714051002","CARISOPRODOL","350MG","30","Select","Select",""],["","60505708102","FENTANYL","25MCG\/HR","10","Select","Select",""],["","00378003210","METOPROL","50MG","60","Select","Select",""],["","68462010630","ONDANSETRON","8MG","90","Select","Select",""],["","00093005805","TRAMADOL","50MG","30","Select","Select",""],["","50383077504","LIDOCAINE","2% VISC","300","Select","Select",""],["","00378064205","PREDNISONE","20MG","9","Select","Select",""],["","42858010201","OXYCOD\/APAP","5-325MG","42","Select","Select",""],["","47335061730","DRIZALMA","30MG DR","7","Select","Select",""],["","68180098103","LISINOPRIL ","20MG","90","Select","Select",""],["","00832105410","BACLOFEN ","10MG","30","Select","Select",""],["","59746000103","METHYLPRED ","4MG","21","Select","Select",""],["","00093031401","KETOROLAC ","10MG","20","Select","Select",""],["","00054418425","DEXAMETHASON ","4MG","60","Select","Select",""],["","59746011306","PROCHLORPER ","5MG","60","Select","Select",""],["","00469012599","XTANDI ","40MG","120","Select","Select",""],["","50383077504","LIDOCAINE ","2% VISC","300","Select","Select",""],["","00378064205","PREDNISONE ","20MG","9","Select","Select",""],["","69097094312","GABAPENTIN ","300MG","180","Select","Select",""],["","00093005805","TRAMADOL ","50MG","30","Select","Select",""],["","16714051002","CARISOPRODOL ","350MG","30","Select","Select",""],["","42858010201","OXYCOD\/APAP ","5-325MG","42","Select","Select",""],["","60505708102","FENTANYL ","25MCG\/HR","10","Select","Select",""],["","68462010630","ONDANSETRON ","8MG","90","Select","Select",""],["","47335061730","DRIZALMA ","30MG DR","7","Select","Select",""],["","00378003210","METOPROL ","50MG","60","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":""}]}]}