{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JESSICA DUCK","gend":1,"add":"9379 DINKY CIR","city":"WINDSOR","state":"VA","zip":"23487-9998","dob":"1992-01-16","pno":"757\/353-7879","cno":"757\/353-7879","email":"","pphy":"HASHMI, AFREEDA A MD","ppno":"","pcpadd":"102 FAIRVIEW DRIVE SUITE B","pcpcity":"FRANKLIN","pcpstate":"VA","pcpzip":23851,"pcpcounty":"","pcpid":161374,"pcpname":"Bayview Hospitalist","insh":"2138201*02","cliId":"","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/516-8019","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E86.0","R11.10","R19.7","N39.0","R31.29","R30.0","Q50.5","N64.4","N30.00","Z72.51","Z11.59","Z20.828","R07.0","R05.","Z00.00","R53.82","F41.9","R00.0","F33.42","F31.0","Z76.89","Z71.89","F51.04","F41.1","G25.71","G25.70","R21.","R10.13","R43.2","R11.2","Z90.710","N13.70","Z79.899","R09.81","Z20.822","R10.2","N83.209","N60.02","F31.60","R11.0","R10.9","R42.","H57.04","K52.9","K21.9","R00.2","M54.5","M79.675","S93.509A"],"date":["2021-01-06","2021-01-06","2021-01-28","2021-06-09","2021-06-09","2021-06-09","2021-04-08","2021-05-28","2021-08-13","2020-05-06","2020-09-13","2020-09-13","2020-09-13","2020-09-13","2020-11-05","2020-11-05","2021-10-14","2021-03-19","2020-11-05","2021-08-25","2021-01-07","2021-07-01","2021-10-14","2021-03-23","2021-04-08","2021-09-22","2020-07-17","2021-01-27","2021-01-28","2021-01-27","2021-05-24","2021-03-17","2021-01-06","2021-01-06","2021-08-12","2021-05-24","2021-05-24","2021-05-28","2021-10-14","2021-01-06","2021-01-06","2021-01-06","2021-07-26","2021-01-14","2021-01-14","2021-01-26","2021-04-27","2021-02-26","2021-02-26"],"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":[["","47781030301","NITROFURANTN","100MG","10","Select","Select",""],["","13668001990","VENLAFAXINE","75MG ER","30","Select","Select",""],["","50742061510","METOPROL","25MG ER","180","Select","Select",""],["","51293081101","PHENAZOPYRID","200MG","6","Select","Select",""],["","65862007701","CIPROFLOXACN","500MG","10","Select","Select",""],["","70710113908","FLUCONAZOLE","150MG","2","Select","Select",""],["","51672404801","CLOTRIM\/BETA","DIPROP","15","Select","Select",""],["","33342032915","TRIAMCINOLON","0.10%","15","Select","Select",""],["","00378064205","PREDNISONE","20MG","-18","Select","Select",""],["","13668013601","ESCITALOPRAM","10MG","60","Select","Select",""],["","00143312601","DICYCLOMINE","10MG","90","Select","Select",""],["","65862042005","SMZ\/TMP","800-160","10","Select","Select",""],["","43547030403","ARIPIPRAZOLE","10MG","30","Select","Select",""],["","55513080060","CORLANOR","5MG","-60","Select","Select",""],["","62175061846","PANTOPRAZOLE","20MG","30","Select","Select",""],["","59651000305","OMEPRAZOLE","40MG","28","Select","Select",""],["","65862039010","ONDANSETRON","4MG ODT","12","Select","Select",""],["","31722057330","ESOMEPRA","40MG DR","30","Select","Select",""],["","79854005026","MELATONIN","3MG CR","30","Select","Select",""],["","69097082607","BENZTROPINE","0.5MG","60","Select","Select",""],["","65162074510","PROMETHAZINE","12.5MG","56","Select","Select",""],["","65862022701","LAMOTRIGINE","25MG","60","Select","Select",""],["","13107008305","LORAZEPAM","0.5MG","90","Select","Select",""],["","23155019201","BUPROPION","100MG","30","Select","Select",""],["","16729020201","BUSPIRONE","10MG","30","Select","Select",""],["","65862051601","NAPROXEN","550MG","90","Select","Select",""],["","59267100002","PFIZER","COVID-19","0","Select","Select",""],["","65862096701","ESZOPICLONE","1MG","30","Select","Select",""],["","65862049001","QUETIAPINE","50MG","60","Select","Select",""],["","47781030301","NITROFURANTN ","CAP 100MG","10","Select","Select",""],["","13668001990","VENLAFAXINE ","CAP 75MG ER","30","Select","Select",""],["","51293081101","PHENAZOPYRID ","TAB 200MG","6","Select","Select",""],["","50742061510","METOPROL ","TAB 25MG ER","180","Select","Select",""],["","65862007701","CIPROFLOXACN ","TAB 500MG","10","Select","Select",""],["","70710113908","FLUCONAZOLE ","TAB 150MG","2","Select","Select",""],["","33342032915","TRIAMCINOLON ","CRE 0.001","15","Select","Select",""],["","00378064205","PREDNISONE ","TAB 20MG","-18","Select","Select",""],["","51672404801","CLOTRIM\/BETA ","CRE DIPROP","15","Select","Select",""],["","13668013601","ESCITALOPRAM ","TAB 10MG","60","Select","Select",""],["","62175061846","PANTOPRAZOLE ","TAB 20MG","30","Select","Select",""],["","59651000305","OMEPRAZOLE ","CAP 40MG","28","Select","Select",""],["","13107008305","LORAZEPAM ","TAB 0.5MG","90","Select","Select",""],["","43547030303","ARIPIPRAZOLE ","TAB 5MG","30","Select","Select",""],["","31722057330","ESOMEPRA ","CAP 40MG DR","-90","Select","Select",""],["","65162074510","PROMETHAZINE ","TAB 12.5MG","56","Select","Select",""],["","00143122701","DICYCLOMINE ","TAB 20MG","30","Select","Select",""],["","55513080060","CORLANOR ","TAB 5MG","60","Select","Select",""],["","65862022801","LAMOTRIGINE ","TAB 100MG","30","Select","Select",""],["","23155019101","BUPROPION ","TAB 75MG","30","Select","Select",""],["","79854005026","MELATONIN ","TAB 3MG CR","60","Select","Select",""],["","69097082707","BENZTROPINE ","TAB 1MG","-30","Select","Select",""],["","65862051601","NAPROXEN ","TAB 550MG","90","Select","Select",""],["","16729020301","BUSPIRONE ","TAB 15MG","60","Select","Select",""],["","59267100002","PFIZER ","INJ COVID-19","0","Select","Select",""],["","65862049001","QUETIAPINE ","TAB 50MG","60","Select","Select",""],["","65862042005","SMZ\/TMP ","TAB 800-160","6","Select","Select",""],["","65862096701","ESZOPICLONE ","TAB 1MG","30","Select","Select",""],["","65862039010","ONDANSETRON ","TAB 4MG ODT","12","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","",""],["No","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":""}]}]}