{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JASON   F DUCK SR","gend":0,"add":"22515 STEVE MILL ROAD","city":"WINDSOR","state":"VA","zip":"23487-9998","dob":"1964-08-10","age":"","mstatus":"","insh":"2138202*01","cliId":"","pno":"757\/448-7013","cno":"757\/448-7013","email":"","ename":"","eno":"","pphy":"WUNDERLICH, JOANNE R MD","ppno":"757\/668-2600","pcpadd":"SUITE 220 1005 COMMERCIAL LANE","pcpcity":"SUFFOLK","pcpstate":"VA","pcpzip":23434,"pcpcounty":"","pcpid":152665,"pcpname":"CMG - Nansemond Pediatrics","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K76.0","N40.1","N13.8","I10.","E78.2","R05.","I71.2","R19.00","Z98.890","Z86.79","T15.10XA","R10.13","R91.8","N28.1","R16.2","H90.3","J20.9","E66.9","Z68.41","Z82.49","Z87.891","Z88.8","Z88.0","R51.","I87.1","J98.4","R16.1","Z95.828","K31.7","R16.0","K42.9","R14.0","Z30.09","J06.9","J45.909","H25.13","B96.81","K29.70","Z00.00","N28.89","Z20.828","R07.89","E78.5","R61.","N52.9","Z20.822","Z12.11"],"date":["2021-05-18","2021-04-08","2021-05-18","2021-09-27","2021-05-18","2020-03-15","2021-05-04","2021-05-04","2021-05-18","2021-05-18","2020-09-10","2020-10-30","2021-05-04","2021-05-04","2021-05-04","2020-01-17","2020-03-15","2020-03-15","2020-03-15","2020-03-15","2020-03-15","2020-03-15","2020-03-15","2020-03-15","2020-07-24","2020-07-24","2020-07-24","2020-07-24","2020-10-07","2020-10-30","2020-10-30","2020-10-30","2021-08-04","2020-03-12","2020-03-12","2020-10-23","2021-04-20","2021-04-20","2021-05-18","2020-08-12","2020-11-19","2021-07-15","2021-07-15","2021-07-15","2021-09-27","2021-08-12","2021-08-30"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",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":[["","68180036109","FENOFIBRATE","145MG","30","Select","Select",""],["","68180098003","LISINOPRIL","10MG","30","Select","Select",""],["","00456141030","BYSTOLIC","10MG","45","Select","Select",""],["","70377002811","ATORVASTATIN","20MG","30","Select","Select",""],["","62175061743","PANTOPRAZOLE","40MG","90","Select","Select",""],["","65862035790","CLOPIDOGREL","75MG","90","Select","Select",""],["","27808008601","HYD","10-8\/5ML","100","Select","Select",""],["","55111015810","OMEPRAZOLE","20MG","20","Select","Select",""],["","50111033301","METRONIDAZOL","250MG","40","Select","Select",""],["","63304069205","CLINDAMYCIN","150MG","16","Select","Select",""],["","60432027516","BROM\/PSE\/DM","","120","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","00093317431","ALBUTEROL","HFA","8","Select","Select",""],["","00116200116","CHLORHEX","0.12%","473","Select","Select",""],["","68180016013","AZITHROMYCIN","250MG","6","Select","Select",""],["","59746017509","PREDNISONE","20MG","15","Select","Select",""],["","58914060120","PYLERA","","40","Select","Select",""],["","69238152201","TETRACYCLINE","250MG","40","Select","Select",""],["","00093534356","SILDENAFIL","100MG","30","Select","Select",""],["","50428642686","CVS","262MG","40","Select","Select",""],["","68180036109","FENOFIBRATE ","145MG","30","Select","Select",""],["","65862035790","CLOPIDOGREL ","75MG","90","Select","Select",""],["","00456141030","BYSTOLIC ","10MG","45","Select","Select",""],["","70377002811","ATORVASTATIN ","20MG","30","Select","Select",""],["","68180098003","LISINOPRIL ","10MG","30","Select","Select",""],["","00378064110","PREDNISONE ","10MG","12","Select","Select",""],["","62175061743","PANTOPRAZOLE ","40MG","90","Select","Select",""],["","60432027516","BROM\/PSE\/DM ","","120","Select","Select",""],["","27808008601","HYD ","10-8\/5ML","100","Select","Select",""],["","00093317431","ALBUTEROL ","HFA","8","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","68180016013","AZITHROMYCIN ","250MG","6","Select","Select",""],["","58914060120","PYLERA ","","40","Select","Select",""],["","50428642686","CVS ","262MG","40","Select","Select",""],["","50111033301","METRONIDAZOL ","250MG","40","Select","Select",""],["","00116200116","CHLORHEX ","0.12%","473","Select","Select",""],["","00093534356","SILDENAFIL ","100MG","30","Select","Select",""],["","63304069205","CLINDAMYCIN ","150MG","16","Select","Select",""],["","55111015810","OMEPRAZOLE ","20MG","20","Select","Select",""],["","69238152201","TETRACYCLINE ","250MG","40","Select","Select",""],["","13668035530","NEBIVOLOL","10MG","45","Select","Select",""],["","13668035530","NEBIVOLOL ","TAB 10MG","-45","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":""}]}]}