{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ANA   R TAPPEN","gend":1,"add":"2619 HARTLEY ST","city":"VIRGINIA BEACH","state":"VA","zip":"23456-9998","dob":"1974-03-05","age":"","mstatus":"","insh":"2092423*01","cliId":"","pno":"757\/291-6043","cno":"757\/291-6043","email":"","ename":"","eno":"","pphy":"MANDELL JR, M STEPHEN MD","ppno":"757\/962-6262","pcpadd":"121 COURTHOUSE LN","pcpcity":"BOWLING GREEN","pcpstate":"VA","pcpzip":22427,"pcpcounty":"","pcpid":195552,"pcpname":"Trinity Medical Care PC","plan":"OHP","program":"ACA","lob":"Individual","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/633-4438","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N63.0","R11.0","K63.89","D25.9","R10.84","R19.7","K52.832","M51.16","M47.816","K29.00","R10.13","Z79.899","Z71.89","M54.16","M51.26","B36.0","Z20.828","J06.9","R43.9","R10.10","T78.49XA","F41.9","J45.909","M54.5","K58.9","Z00.00","Z12.31","R93.5","Z01.419","K62.1","K64.0","K22.8","K31.89","K20.0","Z20.822","R53.83","R51.9","R10.9"],"date":["2021-03-25","2021-08-20","2021-05-11","2021-03-30","2021-03-30","2021-08-20","2021-06-18","2020-12-10","2020-12-10","2021-03-30","2021-03-30","2021-03-30","2020-09-23","2020-12-10","2021-05-07","2021-06-07","2020-10-23","2020-10-23","2020-10-23","2021-05-11","2020-07-21","2020-12-16","2020-09-14","2021-06-11","2020-09-14","2021-01-13","2021-03-25","2021-05-11","2021-01-13","2021-05-11","2021-05-11","2021-05-11","2021-05-11","2021-06-18","2021-02-11","2021-02-11","2021-02-11","2021-08-20"],"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":[["","00172392670","DIAZEPAM","5MG","5","Select","Select",""],["","10702001801","OXYCODONE","5MG","20","Select","Select",""],["","68382004110","PROMETHAZINE","25MG","8","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","24689078501","BUSPIRONE","7.5MG","90","Select","Select",""],["","50111033402","METRONIDAZOL","500MG","14","Select","Select",""],["","51525011301","HYOSCYAMINE","0.125MG","30","Select","Select",""],["","00591352530","LIDOCAINE","5%","30","Select","Select",""],["","51672131802","CICLOPIROX","0.77%","90","Select","Select",""],["","31722070590","VALACYCLOVIR","1GM","-6","Select","Select",""],["","57237007530","ONDANSETRON","4MG","-15","Select","Select",""],["","31722072610","MONTELUKAST","10MG","30","Select","Select",""],["","61442010201","DICLOFENAC","50MG DR","-60","Select","Select",""],["","45802046564","KETOCONAZOLE","2%","120","Select","Select",""],["","59746000103","METHYLPRED","4MG","21","Select","Select",""],["","00406051201","OXYCOD\/APAP","5-325MG","-30","Select","Select",""],["","65162006205","SUCRALFATE","1GM\/10ML","420","Select","Select",""],["","55111015810","OMEPRAZOLE","20MG","30","Select","Select",""],["","00093506110","HYDROXYZ","25MG","28","Select","Select",""],["","45802008801","ALBUTEROL","HFA","8","Select","Select",""],["","64380080707","IBUPROFEN","800MG","90","Select","Select",""],["","57237000511","FLUCONAZOLE","150MG","1","Select","Select",""],["","47781030301","NITROFURANTN","100MG","10","Select","Select",""],["","31722053301","METHOCARBAM","500MG","42","Select","Select",""],["","10702001801","OXYCODONE ","5MG","20","Select","Select",""],["","68382004110","PROMETHAZINE ","25MG","8","Select","Select",""],["","00172392670","DIAZEPAM ","5MG","5","Select","Select",""],["","31722072610","MONTELUKAST ","10MG","30","Select","Select",""],["","00093506110","HYDROXYZ ","25MG","28","Select","Select",""],["","59746000103","METHYLPRED ","4MG","21","Select","Select",""],["","51525011301","HYOSCYAMINE ","0.125MG","30","Select","Select",""],["","45802008801","ALBUTEROL ","HFA","8","Select","Select",""],["","24689078501","BUSPIRONE ","7.5MG","90","Select","Select",""],["","31722070590","VALACYCLOVIR ","1GM","6","Select","Select",""],["","00591352530","LIDOCAINE ","5%","30","Select","Select",""],["","51672131802","CICLOPIROX ","0.77%","-90","Select","Select",""],["","57237007530","ONDANSETRON ","4MG","15","Select","Select",""],["","29300022705","METRONIDAZOL ","500MG","14","Select","Select",""],["","55111015810","OMEPRAZOLE ","20MG","30","Select","Select",""],["","65162006205","SUCRALFATE ","1GM\/10ML","420","Select","Select",""],["","00406051201","OXYCOD\/APAP ","5-325MG","-30","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","64380080707","IBUPROFEN ","800MG","90","Select","Select",""],["","47781030301","NITROFURANTN ","100MG","10","Select","Select",""],["","31722053301","METHOCARBAM ","500MG","30","Select","Select",""],["","61442010201","DICLOFENAC ","50MG DR","30","Select","Select",""],["","68462011944","FLUCONAZOLE ","150MG","4","Select","Select",""],["","45802046564","KETOCONAZOLE ","2%","120","Select","Select",""],["","13107005999","APAP\/CODEINE ","300-30MG","28","Select","Select",""],["","62175061743","PANTOPRAZOLE ","40MG","180","Select","Select",""],["","13107005999","APAP\/CODEINE","300-30MG","28","Select","Select",""],["","62175061743","PANTOPRAZOLE","40MG","-180","Select","Select",""],["","65862050320","AMOX\/K","875-125","10","Select","Select",""],["","52817033200","CYCLOBENZAPR","10MG","12","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":""}]}]}