{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"FRED   DUANE JARRELL","gend":0,"add":"841 OLD GEO WASH HWY N","city":"CHESAPEAKE","state":"VA","zip":"23323-9998","dob":"1958-08-25","age":"","mstatus":"","insh":"2116531*01","cliId":"","pno":"757\/485-7329","cno":"757\/485-7329","email":"","ename":"","eno":"","pphy":"ESPINO, STEPHANIE L DO","ppno":"757\/548-0076","pcpadd":"725 VOLVO PKWY STE 100","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":23320,"pcpcounty":"","pcpid":129852,"pcpname":"Volvo Medical Associates","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"757\/737-3496","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/548-1652","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z12.11","I25.5","I47.2","Z95.0","H16.032","H44.009","Z95.810","I42.8","Z87.891","I25.10","I10.","E78.00","R73.03","F41.1","H16.012","Z12.2","H44.002","H25.12","H25.11","Z45.02","H18.20","H16.122","I65.29","J45.909","F41.9","J18.9","D64.9","B00.59","J01.00","H60.92","H20.052","Z00.00","Z94.7","H16.062","I25.2","Z12.5","I65.21","I65.23","Z86.79","K21.9","J30.9","H44.19","F41.8","H18.9","H16.8","Z98.890","Z86.74","Z88.8","Z79.899","Z79.82","H16.002","J32.8","Z01.818","T86.8412","I49.1"],"date":["2021-08-30","2021-10-06","2021-10-06","2020-10-08","2021-06-11","2021-06-23","2021-10-06","2021-04-07","2021-09-20","2021-09-20","2021-09-20","2021-09-08","2021-08-10","2020-04-21","2021-09-20","2020-05-14","2021-08-20","2021-08-11","2021-08-11","2021-01-06","2021-06-10","2021-05-14","2020-09-16","2021-08-03","2020-09-16","2020-01-10","2021-08-03","2021-05-19","2021-04-05","2021-04-05","2021-06-11","2021-08-10","2021-09-01","2021-06-11","2021-09-20","2021-08-03","2021-08-03","2021-08-03","2021-08-04","2021-08-03","2021-08-03","2021-09-20","2021-08-10","2021-08-10","2021-08-20","2021-08-31","2021-09-20","2021-09-20","2021-09-20","2021-09-20","2021-08-20","2021-08-31","2021-09-08","2021-08-20","2021-09-08"],"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":[["","00093317431","ALBUTEROL","HFA","8","Select","Select",""],["","68001015103","CARVEDILOL","12.5MG","270","Select","Select",""],["","67877057305","BENZONATATE","100MG","15","Select","Select",""],["","00456114030","VIIBRYD","40MG","30","Select","Select",""],["","31722072250","LEVOFLOXACIN","500MG","10","Select","Select",""],["","60505082901","FLUTICASONE","50MCG","48","Select","Select",""],["","57237017190","ROSUVASTATIN","40MG","90","Select","Select",""],["","80777027399","MODERNA","COVID-19","0","Select","Select",""],["","24208060203","PROLENSA","0.07%","3","Select","Select",""],["","00378427677","VALACYCLOVIR","1GM","42","Select","Select",""],["","61314063715","PREDNISOLONE","1% OP","15","Select","Select",""],["","68462057330","VORICONAZOLE","200MG","30","Select","Select",""],["","0","","","10","Select","Select",""],["","24208053535","ZIRGAN","0.15%","5","Select","Select",""],["","61314065605","CIPROFLOXACN","0.3% OP","-5","Select","Select",""],["","55111011230","MOXIFLOXACIN","400MG","7","Select","Select",""],["","00085433401","ASMANEX","200 MCG","13","Select","Select",""],["","24208079535","NEO\/POLY\/DEX","0.1% OP","4","Select","Select",""],["","00143980305","DOXYCYCL","100MG","28","Select","Select",""],["","00065064515","NATACYN","5% OP","15","Select","Select",""],["","43598032675","CIPRO\/DEXA","0.3-0.1%","8","Select","Select",""],["","42571016242","AMOX\/K","875-125","20","Select","Select",""],["","00093317431","ALBUTEROL ","HFA","8","Select","Select",""],["","67877057305","BENZONATATE ","100MG","15","Select","Select",""],["","31722072250","LEVOFLOXACIN ","500MG","10","Select","Select",""],["","00456114030","VIIBRYD ","40MG","30","Select","Select",""],["","60505082901","FLUTICASONE ","50MCG","48","Select","Select",""],["","57237017190","ROSUVASTATIN ","40MG","90","Select","Select",""],["","00085433401","ASMANEX ","200 MCG","13","Select","Select",""],["","68001015103","CARVEDILOL ","12.5MG","270","Select","Select",""],["","80777027399","MODERNA ","COVID-19","0","Select","Select",""],["","42571016242","AMOX\/K ","875-125","20","Select","Select",""],["","43598032675","CIPRO\/DEXA ","0.3-0.1%","8","Select","Select",""],["","61314065605","CIPROFLOXACN ","0.3% OP","5","Select","Select",""],["","00065064515","NATACYN ","5% OP","15","Select","Select",""],["","24208079535","NEO\/POLY\/DEX ","0.1% OP","4","Select","Select",""],["","24208060203","PROLENSA ","0.07%","3","Select","Select",""],["","24208053535","ZIRGAN ","0.15%","-5","Select","Select",""],["","13668020130","MOXIFLOXACIN ","400MG","7","Select","Select",""],["","68462057330","VORICONAZOLE ","200MG","14","Select","Select",""],["","61314063710","PREDNISOLONE ","1% OP","-10","Select","Select",""],["","00378427677","VALACYCLOVIR ","1GM","42","Select","Select",""],["","00143980305","DOXYCYCL ","100MG","28","Select","Select",""],["","61314039603","CYCLOPENTOL ","1% OP","-15","Select","Select",""],["","67877019710","AMLODIPINE","2.5MG","30","Select","Select",""],["","68001024617","ONDANSETRON","4MG ODT","10","Select","Select",""],["","42858010250","OXYCOD\/APAP","5-325MG","20","Select","Select",""],["","61314039603","CYCLOPENTOL","1% OP","-15","Select","Select",""],["","67877032105","IBUPROFEN","800MG","90","Select","Select",""],["","42858010250","OXYCOD\/APAP ","TAB 5-325MG","20","Select","Select",""],["","67877019710","AMLODIPINE ","TAB 2.5MG","30","Select","Select",""],["","68001024617","ONDANSETRON ","TAB 4MG ODT","10","Select","Select",""],["","67877032105","IBUPROFEN ","TAB 800MG","90","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":""}]}]}