{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LORRIE   B ELGIN","gend":1,"add":"3633 MOORE ROAD","city":"PORTSMOUTH","state":"VA","zip":"23703-9998","dob":"1963-07-28","age":"","mstatus":"","insh":"2137206*01","cliId":"","pno":"757\/434-0553","cno":"757\/434-0553","email":"","ename":"","eno":"","pphy":"MOSELEY, HEATHER MD","ppno":"757\/689-8430","pcpadd":"1925 GLEN MITCHELL DR. STE 100","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23456,"pcpcounty":"","pcpid":110777,"pcpname":"Princess Anne Medical Associates","plan":"OHP","program":"ACA","lob":"Individual","region":"TIDEWATER","aligned":"","ano":"757\/434-7624","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/689-8435","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z03.89","E11.9","E78.5","F98.8","J01.90","H40.2231","H16.223","H10.45","H26.492","G47.33","D31.32","E55.9","S61.452A","F90.9","H40.9","Z88.2","Z88.1","Z23.","J44.9","F32.9","E66.9","H26.491","F41.9","F90.0","Z12.11","H26.493","Z98.41","Z98.42","Z12.31","J06.9","J32.9","J45.909","F17.200","S82.002A","M17.12","S82.032D","Z01.810","S82.032A","S80.211A","S89.92XA","S82.131A","Z01.812","M62.81"],"date":["2020-06-27","2021-11-19","2021-09-20","2020-08-18","2021-07-16","2021-11-19","2021-11-19","2020-08-14","2021-01-15","2020-12-15","2021-11-19","2020-11-24","2020-06-27","2020-06-27","2020-06-27","2020-06-27","2021-09-23","2020-06-27","2020-11-24","2021-06-11","2020-11-24","2020-12-04","2021-09-20","2021-09-20","2021-05-23","2020-11-17","2020-11-17","2020-11-17","2020-12-29","2020-03-16","2020-03-16","2020-03-16","2020-03-16","2021-10-13","2021-09-22","2021-10-22","2021-10-13","2021-10-14","2021-09-23","2021-09-23","2021-10-01","2021-10-13","2021-10-13"],"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":[["","65862069790","VENLAFAXINE ","150MG ER","30","Select","Select",""],["","00406888501","AMPHET\/DEXTR ","15MG","60","Select","Select",""],["","68382005101","MELOXICAM ","15MG","30","Select","Select",""],["","59651027001","GLIPIZIDE ","10MG","30","Select","Select",""],["","54092038501","ADDERALL ","15MG","30","Select","Select",""],["","31722082030","ARIPIPRAZOLE ","5MG","30","Select","Select",""],["","00603533815","PREDNISONE ","10MG","21","Select","Select",""],["","31722072250","LEVOFLOXACIN ","500MG","14","Select","Select",""],["","65862057490","MONTELUKAST ","10MG","30","Select","Select",""],["","21292000616","TRUE ","GLUCOSE","100","Select","Select",""],["","27808015601","ROSUVASTATIN ","10MG","90","Select","Select",""],["","45802005935","NYSTATIN ","100000","30","Select","Select",""],["","10702020101","OXYBUTYNIN ","5MG","180","Select","Select",""],["","31722094101","HYDROCO\/APAP ","5-325MG","12","Select","Select",""],["","00378400505","ALPRAZOLAM ","1MG","120","Select","Select",""],["","00143924920","AMOX\/K ","875-125","20","Select","Select",""],["","61314054701","LATANOPROST ","0.01%","2","Select","Select",""],["","42571014126","DORZOLAMIDE ","2% OP","10","Select","Select",""],["","53885024450","ONETOUCH ","ULTRA","50","Select","Select",""],["","68462053670","IMIQUIMOD ","5%","12","Select","Select",""],["","33332032001","AFLURIA ","2020-21","0","Select","Select",""],["","60758077305","KETOROLAC ","0.40%","5","Select","Select",""],["","59267100001","PFIZER ","COVID-19","0","Select","Select",""],["","65862069790","VENLAFAXINE","150MG ER","90","Select","Select",""],["","00406888501","AMPHET\/DEXTR","15MG","60","Select","Select",""],["","59651027001","GLIPIZIDE","10MG","30","Select","Select",""],["","54092038501","ADDERALL","15MG","30","Select","Select",""],["","68382005101","MELOXICAM","15MG","30","Select","Select",""],["","00603533815","PREDNISONE","10MG","21","Select","Select",""],["","31722082030","ARIPIPRAZOLE","5MG","30","Select","Select",""],["","45802005935","NYSTATIN","100000","30","Select","Select",""],["","31722072250","LEVOFLOXACIN","500MG","14","Select","Select",""],["","00378400505","ALPRAZOLAM","1MG","120","Select","Select",""],["","65862057490","MONTELUKAST","10MG","30","Select","Select",""],["","21292000616","TRUE","GLUCOSE","100","Select","Select",""],["","10702020101","OXYBUTYNIN","5MG","-180","Select","Select",""],["","31722094101","HYDROCO\/APAP","5-325MG","12","Select","Select",""],["","27808015601","ROSUVASTATIN","10MG","90","Select","Select",""],["","00143924920","AMOX\/K","875-125","20","Select","Select",""],["","61314054701","LATANOPROST","0.01%","2","Select","Select",""],["","33332032001","AFLURIA","2020-21","0","Select","Select",""],["","42571014126","DORZOLAMIDE","2% OP","10","Select","Select",""],["","53885024450","ONETOUCH","ULTRA","50","Select","Select",""],["","68462053670","IMIQUIMOD","5%","12","Select","Select",""],["","60758077305","KETOROLAC","0.40%","5","Select","Select",""],["","59267100001","PFIZER","COVID-19","0","Select","Select",""],["","00406051201","OXYCOD\/APAP","5-325MG","18","Select","Select",""],["","49281042150","FLUZONE","2021-22","0","Select","Select",""],["","69547035302","NARCAN","","-2","Select","Select",""],["","88888888887","DMR","","1","Select","Select",""],["","00406051201","OXYCOD\/APAP ","TAB 5-325MG","15","Select","Select",""],["","49281042150","FLUZONE ","INJ 2021-22","0","Select","Select",""],["","69547035302","NARCAN ","SPR ","-2","Select","Select",""],["","88888888887","DMR ","T ","1","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":""}]}]}