{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BEVERLY SAWYER","gend":1,"add":"2237 GENERAL BOOTH BLVD","city":"VIRGINIA BEACH","state":"VA","zip":"23456-9998","dob":"1959-10-31","age":"","mstatus":"","insh":"2098177*01","cliId":"","pno":"757\/427-3283","cno":"757\/427-3283","email":"","ename":"","eno":"","pphy":"MILLER, MITCHELL B MD","ppno":"757\/563-2800","pcpadd":"STE 102 2109 MCCOMAS WAY","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23454,"pcpcounty":"","pcpid":108567,"pcpname":"Coastal Family Practice PC","plan":"OHP","program":"ACA","lob":"Individual","region":"TIDEWATER","aligned":"","ano":"757\/335-9846","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/563-2300","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M16.31","M25.559","Z01.818","M16.32","R11.2","I95.89","Z98.890","M25.551","Z12.31","N60.32","N60.22","R92.8","N64.89","M16.12","M41.9","M43.16","M47.817","G89.29","Z13.820","Z78.0","M85.89","M25.552","Z96.642","M54.5","M47.816","G57.11","Z47.1","Z96.641","Z79.82","Z86.718","L90.5","R92.1","Z96.651","Z86.711","E66.9","Z68.34","Z79.1","Z74.09","Z20.828","M54.16","M16.11","R94.31","M19.90","Q65.89","M81.0","Z96.643","Z68.33","Z91.81","Z01.812","H25.13","H52.13","H52.223","L24.7","Z12.11","E66.09","M54.9","N39.3","R60.0","Z65.9","Z68.37"],"date":["2020-08-31","2021-01-09","2021-01-09","2020-09-01","2020-09-01","2020-09-01","2020-09-01","2020-10-06","2020-11-04","2020-11-16","2020-11-16","2020-11-16","2020-12-22","2021-11-16","2020-02-25","2020-02-25","2020-02-25","2020-08-04","2020-10-29","2020-10-29","2020-10-29","2021-02-12","2021-08-10","2020-04-28","2020-05-20","2020-05-04","2021-02-01","2021-08-10","2021-02-01","2021-02-01","2020-11-16","2020-11-16","2021-01-05","2021-02-01","2021-02-01","2021-01-13","2021-01-13","2021-01-13","2021-01-09","2020-04-28","2020-08-31","2020-07-07","2020-07-07","2020-08-27","2020-10-29","2021-02-01","2021-02-01","2021-02-01","2020-08-27","2020-12-07","2020-12-07","2020-12-07","2021-05-28","2021-05-23","2021-11-16","2021-11-16","2021-11-16","2021-11-16","2021-11-16","2021-11-16"],"priorHcc":["","","","","","","","","","","","","",null,"","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",null,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":[["","59746021106","CYCLOBENZAPR","5MG","15","Select","Select",""],["","59746017506","PREDNISONE","20MG","10","Select","Select",""],["","58160082311","SHINGRIX","50\/0.5ML","1","Select","Select",""],["","49348098023","SM","81MG EC","60","Select","Select",""],["","00904645780","DOK","100MG","40","Select","Select",""],["","80777027399","MODERNA","COVID-19","0","Select","Select",""],["","16571020110","DICLOFENAC","75MG DR","60","Select","Select",""],["","57237002801","AMOXICILLIN","500MG","4","Select","Select",""],["","57896022110","ACETAMIN","500MG","80","Select","Select",""],["","68382005101","MELOXICAM","15MG","40","Select","Select",""],["","65162062711","TRAMADOL","50MG","20","Select","Select",""],["","70461032003","FLUCLVX","2020-21","0","Select","Select",""],["","65862039010","ONDANSETRON","4MG ODT","30","Select","Select",""],["","59746021106","CYCLOBENZAPR ","5MG","15","Select","Select",""],["","59746017506","PREDNISONE ","20MG","5","Select","Select",""],["","16571020110","DICLOFENAC ","75MG DR","60","Select","Select",""],["","49348098023","SM ","81MG EC","60","Select","Select",""],["","68382005101","MELOXICAM ","15MG","40","Select","Select",""],["","57896022110","ACETAMIN ","500MG","80","Select","Select",""],["","00904645780","DOK ","100MG","40","Select","Select",""],["","65162062711","TRAMADOL ","50MG","20","Select","Select",""],["","70461032003","FLUCLVX ","2020-21","0","Select","Select",""],["","58160082311","SHINGRIX ","50\/0.5ML","1","Select","Select",""],["","65862039010","ONDANSETRON ","4MG ODT","30","Select","Select",""],["","80777027399","MODERNA ","COVID-19","0","Select","Select",""],["","57237002801","AMOXICILLIN ","500MG","4","Select","Select",""],["","33332032101","AFLURIA","2021-22","0","Select","Select",""],["","33332032101","AFLURIA ","INJ 2021-22","0","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":""}]}]}