{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JAIMIN   K PATEL","gend":0,"add":"101 BASTILLE CT","city":"WILLIAMSBURG","state":"VA","zip":"23185-9998","dob":"1963-04-01","pno":"757\/358-5117","cno":"757\/358-5117","email":"","pphy":"PARIKH, PRANAV MD","ppno":"","pcpadd":"STE 400 400 SENTARA CIR","pcpcity":"WILLIAMSBURG","pcpstate":"VA","pcpzip":23188,"pcpcounty":"","pcpid":119566,"pcpname":"WILLIAMSBURG INTERNAL MEDICINE","insh":"2125368*01","cliId":"","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/645-3149","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z12.11","Z20.828","M31.0","L95.8","R94.5","Z79.899","R07.9","R10.12","R56.9","I77.6","Z71.9","R55.","S30.1XXA","S20.221A","J18.9","K76.0","E11.649","R00.0","E66.3","Z68.33","Z79.84","Z79.52","Z98.84","Z79.82","E11.65","E78.00","I10.","M25.561","R74.8","R07.81","J18.1","R09.89","E11.9","B86.","R09.81","L95.9","M79.89","M25.542","M79.602","R21."],"date":["2021-08-30","2021-03-12","2021-07-23","2021-07-23","2021-05-19","2021-07-23","2021-06-02","2021-06-02","2021-07-12","2021-06-16","2021-01-14","2021-09-20","2021-06-02","2021-06-02","2021-06-02","2021-06-02","2021-06-02","2021-06-02","2021-06-02","2021-06-02","2021-06-02","2021-06-02","2021-06-02","2021-06-02","2021-09-27","2021-09-27","2021-09-27","2021-07-23","2021-07-23","2020-06-19","2020-06-19","2020-06-19","2020-11-21","2020-11-08","2020-11-08","2020-11-21","2020-11-21","2020-11-21","2020-11-21","2020-11-21"],"priorHcc":[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":[["","60505014101","GLIPIZIDE","5MG","180","Select","Select",""],["","68180051201","LISINOPRIL","2.5MG","90","Select","Select",""],["","59746036030","VALSARTAN","40MG","60","Select","Select",""],["","00006057561","JANUMET","50-500MG","180","Select","Select",""],["","53489011905","DOXYCYCL","100MG","28","Select","Select",""],["","67877032005","IBUPROFEN","600MG","20","Select","Select",""],["","58160082311","SHINGRIX","50\/0.5ML","1","Select","Select",""],["","00378064110","PREDNISONE","10MG","24","Select","Select",""],["","68462053253","CLOBETASOL","0.05%","100","Select","Select",""],["","00054327099","FLUTICASONE","50MCG","16","Select","Select",""],["","21922002107","PERMETHRIN","5%","60","Select","Select",""],["","59746000103","METHYLPRED","4MG","21","Select","Select",""],["","00378001401","METHOTREXATE","2.5MG","24","Select","Select",""],["","59267100003","PFIZER","COVID-19","0","Select","Select",""],["","57599080000","FREESTY","2 SENSOR","6","Select","Select",""],["","69315012710","FOLIC","1000MCG","90","Select","Select",""],["","57599000101","FREESTYLE KIT SENSOR","SENSOR","6","Select","Select",""],["","68180016013","AZITHROMYCIN","250MG","6","Select","Select",""],["","59651000305","OMEPRAZOLE","40MG","90","Select","Select",""],["","00591565810","CYCLOBENZAPR","10MG","30","Select","Select",""],["","60505014101","GLIPIZIDE ","TAB 5MG","-180","Select","Select",""],["","68180051201","LISINOPRIL ","TAB 2.5MG","90","Select","Select",""],["","00006057561","JANUMET ","TAB 50-500MG","180","Select","Select",""],["","59746036030","VALSARTAN ","TAB 40MG","60","Select","Select",""],["","58160082311","SHINGRIX ","INJ 50\/0.5ML","1","Select","Select",""],["","53489011905","DOXYCYCL ","CAP 100MG","28","Select","Select",""],["","67877032005","IBUPROFEN ","TAB 600MG","20","Select","Select",""],["","00054327099","FLUTICASONE ","SPR 50MCG","16","Select","Select",""],["","00378064110","PREDNISONE ","TAB 10MG","30","Select","Select",""],["","00378001401","METHOTREXATE ","TAB 2.5MG","72","Select","Select",""],["","43386009660","CLOBETASOL ","OIN 0.0005","-50","Select","Select",""],["","69315012710","FOLIC ","TAB 1000MCG","90","Select","Select",""],["","57599080000","FREESTY ","KIT 2 SENSOR","6","Select","Select",""],["","59267100002","PFIZER ","INJ COVID-19","0","Select","Select",""],["","68180016013","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","00591565810","CYCLOBENZAPR ","TAB 10MG","30","Select","Select",""],["","57599000101","FREESTYLE    KIT SENSOR","KIT SENSOR","6","Select","Select",""],["","59651000305","OMEPRAZOLE ","CAP 40MG","90","Select","Select",""],["","59746000103","METHYLPRED ","TAB 4MG","21","Select","Select",""],["","21922002107","PERMETHRIN ","CRE 0.05","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":[[["Yes","Select","","","","","Select","",""],["Yes","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":""}]}]}