{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TAYTHERIA   M LANE","gend":1,"add":"1208 CLYDEDALE LN","city":"VIRGINIA BEACH","state":"VA","zip":"23464-9998","dob":"1979-12-12","age":"","mstatus":"","insh":"2196579*01","cliId":"","pno":"757\/348-9019","cno":"757\/348-9019","email":"","ename":"","eno":"","pphy":"WHITEHURST, CANDACE MD","ppno":"757\/622-8358","pcpadd":"930 W 21ST ST STE 100","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23517,"pcpcounty":"","pcpid":207883,"pcpname":"BON SECOURS GHENT STATION MEDICAL ASSOCIATES","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/622-9662","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F43.23","F41.9","F33.1","R07.9","I10.","R10.32","Z86.2","Z13.21","Z13.6","Z13.1","Z13.220","Z13.29","Z12.31","Z13.89","Z13.83","Z68.31","N83.291","N83.12","R07.89","Z09.","Z86.19","Z20.828","R53.81","F43.20","J18.9","R05.","R50.9","R53.83","M79.10","R63.0","U07.1","R06.02","R31.9","J30.1","J12.89","J34.2","G44.89","Z03.818","Z11.59","J30.9","J34.89","Z01.419","Z12.72","N83.292","N83.01","J98.8","R79.89","R10.84","M25.561","G89.29","J30.2","J01.90","J98.01","J32.9","Z87.09","R07.2","R94.31","Z82.49","Z83.3","Z80.3","Z20.822","J06.9"],"date":["2020-08-06","2021-05-04","2020-05-26","2021-01-01","2021-05-04","2020-11-23","2020-11-23","2020-11-23","2020-11-23","2020-11-23","2020-11-23","2020-11-23","2021-01-07","2020-11-23","2020-11-23","2021-05-04","2021-01-27","2020-12-16","2020-07-28","2020-07-28","2020-07-28","2021-08-12","2020-07-28","2021-06-10","2020-06-30","2021-01-01","2020-06-30","2021-03-18","2020-06-30","2020-06-30","2020-10-21","2020-10-21","2020-12-16","2021-06-08","2021-06-08","2021-06-08","2021-06-08","2020-08-11","2020-08-11","2020-10-21","2020-10-21","2020-12-02","2020-12-02","2021-01-27","2021-03-24","2020-07-21","2020-07-21","2021-05-04","2021-05-04","2021-05-04","2021-05-28","2020-08-11","2020-08-11","2020-10-21","2020-10-21","2021-01-01","2021-01-01","2021-01-01","2021-01-01","2021-01-01","2021-03-18","2021-08-12"],"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":[["","67877032105","IBUPROFEN ","800MG","30","Select","Select",""],["","29300012810","HYDROCHLOROT ","25MG","90","Select","Select",""],["","69238110005","DOXYCYCL ","100MG","20","Select","Select",""],["","66685100100","AMOX\/K ","875-125","-20","Select","Select",""],["","60505082901","FLUTICASONE ","50MCG","-16","Select","Select",""],["","00591544305","PREDNISONE ","20MG","10","Select","Select",""],["","00093317431","ALBUTEROL ","HFA","8","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","16571040250","CETIRIZINE ","10MG","30","Select","Select",""],["","31722072690","MONTELUKAST ","10MG","90","Select","Select",""],["","00173085910","BREO ","100-25","60","Select","Select",""],["","60505084805","AZELASTINE ","0.15%","-30","Select","Select",""],["","50111033402","METRONIDAZOL ","500MG","-14","Select","Select",""],["","69452015120","VITAMIN ","50000UNT","4","Select","Select",""],["","00185012201","NITROFURANTN ","100MG","20","Select","Select",""],["","68382091634","METHYLPRED ","4MG","-21","Select","Select",""],["","00591264001","BUT\/APAP\/CAF ","","20","Select","Select",""],["","13668013610","ESCITALOPRAM ","10MG","90","Select","Select",""],["","42571012290","LEVOCETIRIZI ","5MG","90","Select","Select",""],["","67877032105","IBUPROFEN","800MG","30","Select","Select",""],["","29300012810","HYDROCHLOROT","25MG","90","Select","Select",""],["","60505082901","FLUTICASONE","50MCG","-16","Select","Select",""],["","00591544305","PREDNISONE","20MG","10","Select","Select",""],["","00093317431","ALBUTEROL","HFA","8","Select","Select",""],["","69238110005","DOXYCYCL","100MG","20","Select","Select",""],["","16571040250","CETIRIZINE","10MG","30","Select","Select",""],["","66685100100","AMOX\/K","875-125","20","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","00173085910","BREO","100-25","60","Select","Select",""],["","31722072690","MONTELUKAST","10MG","30","Select","Select",""],["","69452015120","VITAMIN","50000UNT","-4","Select","Select",""],["","50111033402","METRONIDAZOL","500MG","14","Select","Select",""],["","00185012201","NITROFURANTN","100MG","20","Select","Select",""],["","60505084805","AZELASTINE","0.15%","-30","Select","Select",""],["","00591264001","BUT\/APAP\/CAF","","20","Select","Select",""],["","59746000103","METHYLPRED","4MG","21","Select","Select",""],["","69097084805","ESCITALOPRAM","10MG","-90","Select","Select",""],["","42571012290","LEVOCETIRIZI","5MG","90","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":""}]}]}