{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DUANE   L COTTON","gend":0,"add":"3017 STRATFORD DR","city":"CHESAPEAKE","state":"VA","zip":"23321-9998","dob":"1970-02-01","pno":"757\/483-7954","cno":"757\/483-7954","email":"","pphy":"LISNER, CHARLES A MD","ppno":"","pcpadd":"STE 900 301 RIVERVIEW AVE","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23510,"pcpcounty":"","pcpid":161498,"pcpname":"SMG - Dedicated Care Center","insh":"2124406*02","cliId":"","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"757\/483-7954","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/510-9278","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z12.5","E78.5","I65.22","R06.00","K76.0","M85.80","E53.8","E55.9","E04.2","Z11.4","K21.9","N40.0","S67.10XD","R52.","M79.646","B35.6","R10.32","K58.9","Z00.00","Z23.","J34.2","H61.20","R68.89","R09.81","E04.9","S20.96XA","T15.12XA","R07.0","H61.23","J34.89","M79.645","N50.819","L53.9","Q55.22","B37.49","R22.1","D34.","H57.12","H01.00A","H01.00B","S60.012A","R68.82","R53.83","R00.2","K52.9","K51.20","K62.6","Z12.11","I70.90"],"date":["2021-10-15","2021-10-15","2021-10-15","2020-02-04","2021-10-15","2021-10-15","2021-10-15","2021-10-15","2021-10-27","2020-02-04","2021-10-15","2021-10-15","2020-07-17","2020-07-17","2020-07-17","2020-09-09","2020-09-09","2021-10-15","2021-10-15","2020-10-09","2020-01-13","2020-01-13","2020-01-13","2020-01-13","2021-01-07","2021-07-14","2021-07-14","2020-07-23","2021-06-22","2021-06-22","2020-07-23","2020-09-29","2020-09-29","2020-09-29","2020-09-29","2021-01-07","2021-01-07","2021-05-20","2021-05-20","2021-05-20","2020-03-09","2020-10-09","2020-10-09","2021-10-15","2020-10-09","2021-09-01","2021-09-01","2021-10-15","2021-10-15"],"priorHcc":[null,null,null,"",null,null,null,null,null,"",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":[["","65862015901","ZOLPIDEM","5MG","30","Select","Select",""],["","00228202796","ALPRAZOLAM","0.25MG","-10","Select","Select",""],["","67877032105","IBUPROFEN","800MG","30","Select","Select",""],["","00093314705","CEPHALEXIN","500MG","28","Select","Select",""],["","00472037945","CLOTRIM\/BETA","DIPROP","45","Select","Select",""],["","00378161001","DICYCLOMINE","10MG","-30","Select","Select",""],["","00023916360","RESTASIS","0.05%","-180","Select","Select",""],["","00093101042","MUPIROCIN","2%","22","Select","Select",""],["","57237002801","AMOXICILLIN","500MG","24","Select","Select",""],["","52268001201","SUPREP","PREP KIT","-354","Select","Select",""],["","65862015901","ZOLPIDEM ","TAB 5MG","30","Select","Select",""],["","00228202796","ALPRAZOLAM ","TAB 0.25MG","30","Select","Select",""],["","67877032105","IBUPROFEN ","TAB 800MG","30","Select","Select",""],["","00093314705","CEPHALEXIN ","CAP 500MG","28","Select","Select",""],["","00472037945","CLOTRIM\/BETA ","CRE DIPROP","45","Select","Select",""],["","00378161001","DICYCLOMINE ","CAP 10MG","30","Select","Select",""],["","00023916360","RESTASIS ","EMU 0.0005","180","Select","Select",""],["","52268001201","SUPREP ","SOL PREP KIT","-354","Select","Select",""],["","57237002801","AMOXICILLIN ","TAB 500MG","24","Select","Select",""],["","00093101042","MUPIROCIN ","OIN 0.02","22","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":""}]}]}