{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CHRISTOPHER   M PRILLAMAN","gend":0,"add":"127 MAUPIN AVE","city":"PORTSMOUTH","state":"VA","zip":"23702-9998","dob":"1969-11-28","age":"","mstatus":"","insh":"2173026*01","cliId":"","pno":"757\/567-2161","cno":"757\/567-2161","email":"","ename":"","eno":"","pphy":"HUBBELL, WILLIAM J MD","ppno":"757\/473-8400","pcpadd":"HAMP RDS-CONTRACT REP 5000 COX RD S","pcpcity":"GLEN ALLEN","pcpstate":"VA","pcpzip":23060,"pcpcounty":"","pcpid":125381,"pcpname":"","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/968-4243","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G40.419","Z01.818","M48.02","Z20.828","M50.01","M50.11","R20.2","I10.","Z87.891","M54.12","Z72.0","G95.20","M48.8X2","M47.12","M25.78","Z98.1","M50.00","R13.10","T17.308A","Z13.5","Z12.11","G54.9","G40.909","M47.22","G43.909","F17.210","J44.9","Z79.899","Z91.81","Z28.21","J43.9","R56.9","R63.8","R13.12","M43.13","R05.","R74.8","F17.200","B35.3","L03.031","N13.30","K86.89","R93.2","K76.89","N13.1"],"date":["2021-07-12","2020-09-21","2020-11-11","2020-09-28","2020-08-20","2020-08-20","2020-07-22","2021-08-18","2020-08-08","2020-06-25","2021-08-18","2020-10-01","2020-08-10","2020-10-01","2020-10-01","2021-01-04","2020-08-20","2020-10-05","2020-10-05","2020-07-22","2021-09-21","2020-09-15","2020-10-01","2020-10-01","2020-10-01","2020-10-01","2020-10-01","2020-10-01","2020-10-01","2020-10-01","2020-08-20","2020-08-20","2020-10-05","2020-10-13","2021-01-04","2021-08-18","2021-10-02","2021-10-02","2021-10-15","2021-10-15","2021-10-22","2021-10-02","2021-10-02","2021-10-22","2021-10-22"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",null,null,null,null,null,null,null,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":[["","59762521001","PHENYTOIN","50MG","-90","Select","Select",""],["","00904667840","OXYCODONE","5MG\/5ML","473","Select","Select",""],["","69547035302","NARCAN","","2","Select","Select",""],["","50428207688","PAIN","160\/5ML","354","Select","Select",""],["","00591565810","CYCLOBENZAPR","10MG","60","Select","Select",""],["","68180072103","AMLODIPINE","10MG","90","Select","Select",""],["","65162021211","PHENYTOIN ","100MG","270","Select","Select",""],["","68180072003","AMLODIPINE ","5MG","30","Select","Select",""],["","69547035302","NARCAN ","","-2","Select","Select",""],["","00904667840","OXYCODONE ","5MG\/5ML","473","Select","Select",""],["","00591565810","CYCLOBENZAPR ","10MG","60","Select","Select",""],["","50428207688","PAIN ","160\/5ML","354","Select","Select",""],["","68180098103","LISINOPRIL ","20MG","90","Select","Select",""],["","00173068220","VENTOLIN ","","18","Select","Select",""],["","66993001968","ALBUTEROL ","HFA","18","Select","Select",""],["","00173068220","VENTOLIN","","18","Select","Select",""],["","66993001968","ALBUTEROL","HFA","18","Select","Select",""],["","68180098103","LISINOPRIL","20MG","90","Select","Select",""],["","51672129801","KETOCONAZOLE","2%","15","Select","Select",""],["","68462018135","CLOTRIMAZOLE","1%","30","Select","Select",""],["","65862042005","SMZ\/TMP","800-160","20","Select","Select",""],["","68180012202","CEPHALEXIN ","CAP 500MG","8","Select","Select",""],["","51672129801","KETOCONAZOLE ","CRE 0.02","15","Select","Select",""],["","68462018135","CLOTRIMAZOLE ","CRE 0.01","30","Select","Select",""],["","65862042005","SMZ\/TMP ","TAB 800-160","20","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":""}]}]}