{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SARAH   V WRIGHT","gend":1,"add":"2601 SPORTSMAN BLVD","city":"SUFFOLK","state":"VA","zip":"23435-9998","dob":"1990-04-13","age":"","mstatus":"","insh":"2160509*01","cliId":"","pno":"757\/472-5356","cno":"757\/472-5356","email":"","ename":"","eno":"","pphy":"STOCKMAN, LYNNE W DO","ppno":"757\/606-1656","pcpadd":"SUITE 15 3235 BRIDGE ROAD","pcpcity":"SUFFOLK","pcpstate":"VA","pcpzip":23435,"pcpcounty":"","pcpid":157406,"pcpname":"North Suffolk Family Medicine","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/606-1657","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z03.818","N76.0","Z11.3","E78.2","R73.03","E55.9","L55.1","Z13.29","R05.","M25.561","E66.01","K21.9","S61.051A","Z23.","K58.9","Z87.42","F41.1","R06.02","E78.00","M54.2","Z20.828","R21.","T63.441A","E66.9","Z68.39","Z88.1","Z88.8","Z88.5","Z88.6","Z91.030","Z91.02","Z91.040","R07.89","E78.5","R00.2","E28.2","Z79.890","Z82.49","R10.12","Z91.09","R94.31","I51.7","I25.2","R07.9","J03.00","F41.0","F41.9","Z71.2","J02.0","J35.1","J02.9","Z88.9","Z92.29","A08.4","R10.84","E86.9","R11.2","R19.7","I08.1","I27.20","Z32.02","Z87.892","L50.0"],"date":["2020-08-18","2021-04-08","2021-04-08","2021-06-09","2021-05-22","2021-06-09","2021-06-09","2021-05-22","2020-02-18","2020-03-03","2020-02-10","2020-02-10","2020-12-24","2020-12-24","2021-04-28","2021-04-28","2020-03-03","2020-03-03","2020-03-03","2020-07-29","2021-04-02","2021-07-03","2021-07-08","2021-07-03","2021-07-03","2021-07-12","2021-07-12","2021-07-12","2021-07-03","2021-07-03","2021-07-12","2021-07-12","2021-07-12","2021-11-17","2021-11-17","2021-07-12","2021-07-12","2021-07-12","2021-07-12","2021-07-19","2021-11-17","2021-07-08","2021-07-08","2021-11-17","2021-07-30","2021-07-19","2021-07-19","2021-06-09","2021-07-29","2021-07-29","2021-07-29","2021-07-29","2021-07-12","2021-10-02","2021-10-02","2021-10-02","2021-10-02","2021-10-02","2021-11-09","2021-11-09","2021-10-02","2021-08-12","2021-11-08"],"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":[["","00591544243","PREDNISONE","10MG","48","Select","Select",""],["","68382050010","OMEPRAZOLE","40MG","30","Select","Select",""],["","51224012230","AZITHROMYCIN","500MG","-5","Select","Select",""],["","67877032105","IBUPROFEN","800MG","30","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","80777027399","MODERNA","COVID-19","0","Select","Select",""],["","66993001968","ALBUTEROL","HFA","18","Select","Select",""],["","42571016242","AMOX\/K","875-125","20","Select","Select",""],["","00173068220","VENTOLIN","","18","Select","Select",""],["","64980051501","OFLOXACIN","0.3% OP","10","Select","Select",""],["","76385012350","METHOCARBAM","500MG","40","Select","Select",""],["","61314063705","PREDNISOLONE","1% OP","5","Select","Select",""],["","43598021055","SSD","1%","50","Select","Select",""],["","49502010202","EPINEPHRINE","0.3MG","2","Select","Select",""],["","29300022705","METRONIDAZOL","500MG","14","Select","Select",""],["","51862094205","DIAZEPAM","5MG","2","Select","Select",""],["","68382050010","OMEPRAZOLE ","40MG","30","Select","Select",""],["","51224012230","AZITHROMYCIN ","500MG","5","Select","Select",""],["","00591544243","PREDNISONE ","10MG","48","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","00093317431","ALBUTEROL ","HFA","8","Select","Select",""],["","76385012350","METHOCARBAM ","500MG","40","Select","Select",""],["","42571016242","AMOX\/K ","875-125","20","Select","Select",""],["","67877032105","IBUPROFEN ","800MG","30","Select","Select",""],["","64980051501","OFLOXACIN ","0.3% OP","10","Select","Select",""],["","51862094205","DIAZEPAM ","5MG","2","Select","Select",""],["","43598021055","SSD ","1%","50","Select","Select",""],["","29300022705","METRONIDAZOL ","500MG","14","Select","Select",""],["","61314063705","PREDNISOLONE ","1% OP","5","Select","Select",""],["","80777027399","MODERNA ","COVID-19","0","Select","Select",""],["","49502010202","EPINEPHRINE ","0.3MG","2","Select","Select",""],["","00173068220","VENTOLIN ","","18","Select","Select",""],["","69315090401","LORAZEPAM ","0.5MG","6","Select","Select",""],["","50383077504","LIDOCAINE ","2% VISC","100","Select","Select",""],["","57237009960","CEFDINIR ","300MG","-20","Select","Select",""],["","69315090405","LORAZEPAM","0.5MG","6","Select","Select",""],["","50383077504","LIDOCAINE","2% VISC","100","Select","Select",""],["","57237009960","CEFDINIR","300MG","20","Select","Select",""],["","57237007710","ONDANSETRON","4MG ODT","8","Select","Select",""],["","70461032103","FLUCLVX","2021-22","0","Select","Select",""],["","57237007710","ONDANSETRON ","TAB 4MG ODT","8","Select","Select",""],["","70461032103","FLUCLVX ","INJ 2021-22","0","Select","Select",""],["","67877025115","TRIAMCINOLON ","CRE 0.001","15","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":""}]}]}