{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DANIELLE CORNETT","gend":1,"add":"107 LUMAR ROAD","city":"SMITHFIELD","state":"VA","zip":"23430-9998","dob":"1986-04-18","age":"","mstatus":"","insh":"2216941*01","cliId":"","pno":"757\/371-1799","cno":"757\/371-1799","email":"","ename":"","eno":"","pphy":"SPERRY, BOBBIE MD","ppno":"757\/838-6335","pcpadd":"SUITE A 9 MANHATTAN SQUARE","pcpcity":"HAMPTON","pcpstate":"VA","pcpzip":23666,"pcpcounty":"","pcpid":410067,"pcpname":"Hampton Family Practice, PLLC","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/838-0612","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R50.9","R53.83","H66.93","M79.10","G35.","Z02.83","N39.0","R05.","Z20.828","R79.89","M79.604","M79.605","R11.0","R53.81","R06.02","E06.3","I47.1","F17.210","E66.9","Z68.36","Z91.040","Z91.09","M79.18","Z76.0","R51.9","J02.9","I10.","E03.9","R07.9","R79.1","N31.9","G43.109","G89.4"],"date":["2020-09-10","2020-09-10","2020-09-10","2020-12-01","2021-09-09","2021-04-05","2020-09-08","2020-09-08","2020-09-08","2020-09-08","2020-09-08","2020-09-08","2020-09-08","2020-09-08","2020-09-08","2020-09-08","2020-09-08","2020-09-08","2020-09-08","2020-09-08","2020-09-08","2020-09-08","2020-09-08","2021-01-02","2020-12-01","2021-04-21","2021-08-25","2021-08-25","2020-09-08","2020-09-08","2021-09-09","2021-08-25","2021-08-25"],"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":[["","68180097501","LEVOTHYROXIN","200MCG","90","Select","Select",""],["","00173068220","VENTOLIN","","18","Select","Select",""],["","68462072029","DROSPIRENONE","ETHY EST","84","Select","Select",""],["","70700011485","LORYNA","3-0.02MG","84","Select","Select",""],["","68462010340","FLUCONAZOLE","150MG","2","Select","Select",""],["","00093005805","TRAMADOL","50MG","28","Select","Select",""],["","00074714811","SYNTHROID","200MCG","-30","Select","Select",""],["","65862052201","NAPROXEN","500MG","20","Select","Select",""],["","62542030104","HYD","10-8\/5ML","50","Select","Select",""],["","66993001968","ALBUTEROL","HFA","18","Select","Select",""],["","50228014610","HYDROCHLOROT","12.5MG","30","Select","Select",""],["","58160088552","FLUARIX","2020-21","0","Select","Select",""],["","00378064110","PREDNISONE","10MG","90","Select","Select",""],["","65862050320","AMOX\/K","875-125","20","Select","Select",""],["","68180016006","AZITHROMYCIN","250MG","6","Select","Select",""],["","68180097501","LEVOTHYROXIN ","200MCG","90","Select","Select",""],["","70700011485","LORYNA ","3-0.02MG","84","Select","Select",""],["","68462072029","DROSPIRENONE ","ETHY EST","84","Select","Select",""],["","00093317431","ALBUTEROL ","HFA","8","Select","Select",""],["","68462010340","FLUCONAZOLE ","150MG","2","Select","Select",""],["","00173068220","VENTOLIN ","","18","Select","Select",""],["","62542030104","HYD ","10-8\/5ML","50","Select","Select",""],["","65862052201","NAPROXEN ","500MG","20","Select","Select",""],["","00074714890","SYNTHROID ","200MCG","30","Select","Select",""],["","00093005805","TRAMADOL ","50MG","120","Select","Select",""],["","00378064110","PREDNISONE ","10MG","30","Select","Select",""],["","65862050320","AMOX\/K ","875-125","20","Select","Select",""],["","50228014610","HYDROCHLOROT ","12.5MG","30","Select","Select",""],["","68180016006","AZITHROMYCIN ","250MG","6","Select","Select",""],["","58160088552","FLUARIX ","2020-21","0","Select","Select",""],["","69097012203","TOPIRAMATE ","25MG","127","Select","Select",""],["","00143992801","CIPROFLOXACN","500MG","10","Select","Select",""],["","69097012203","TOPIRAMATE","25MG","127","Select","Select",""],["","59267100002","PFIZER","COVID-19","0","Select","Select",""],["","59267100002","PFIZER ","INJ COVID-19","0","Select","Select",""],["","00143992801","CIPROFLOXACN ","TAB 500MG","10","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":""}]}]}