{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" BRITTANY LOUISE POOLE","gend":1,"add":"105 WATER WAY APT 13","city":"HAMPTON","state":"VA","zip":"23666-9998","dob":"1990-06-07","age":"","mstatus":"","insh":"2217623*01","cliId":"","pno":"832\/679-4581","cno":"832\/679-4581, ","email":"","ename":"","eno":"","pphy":"JOHNSON, SHONNA J MD","ppno":"757\/850-1311","pcpadd":"191 D FOX HILL ROAD","pcpcity":"HAMPTON","pcpstate":"VA","pcpzip":"23669-9998","pcpcounty":"","pcpid":118380,"pcpname":"Elizabeth Lakes Family Practice","plan":"OHP - OPTIMA","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":["J10.1","L25.9","B34.9","O45.91","O99.511","J45.909","O16.1","Z3A.13","O46.91","D50.0","O10.913","I10.","O14.15","O10.03","Z39.2","R73.9","Z34.02","O34.32","O99.013","O10.919","O36.5930","O16.3","O99.213","Z3A.33","O64.0XX0","O66.5","Z37.0","Z3A.37","O63.0","O10.013","Z32.01","E28.2","E78.5","E55.9","O26.891","R51.","Z3A.00","R09.89","O35.9XX0","O26.872","O16.2","Z3A.21","O26.892","Z3A.22","O09.891","O36.5920","O99.212","Z23.","Z36.89","Z3A.28","Z3A.36","O11.5","R80.9","R82.4","O14.95","G44.209","R11.0","O99.211","E66.9","Z79.899","O46.90","O47.00","Z3A.30","N92.6","J30.9","Z79.84","O10.412","Z3A.17","O46.92","O99.512","R10.13","R30.0","Z79.82","Z88.0","Z91.013","Z91.018","Z3A.29","N92.0","F41.9","Z36.9","R00.0","Z3A.11","R10.11","Z3A.12","O45.92","Z3A.09","R42.","Z3A.32","O26.873","O10.02","O69.89X0","D50.9","O99.02","O99.52","O99.284","O99.214","E66.09","O11.4","O62.0","O70.0","O43.893","R82.90","J01.00","R10.31","O99.282","Z79.51","Z3A.25","O13.3","Z39.1","Z20.828","Z87.42","O10.012","O34.30","Z3A.20","Z3A.34","Z3A.35","O34.33","N30.01","L02.412"],"date":["2020-02-12","2020-02-12","2020-02-12","2020-05-22","2020-05-22","2020-11-05","2020-05-22","2020-05-22","2020-05-22","2021-04-01","2020-11-03","2021-06-16","2020-11-14","2020-11-14","2020-11-14","2021-06-16","2020-09-02","2020-07-18","2020-09-17","2020-10-01","2020-11-02","2020-11-02","2020-11-02","2020-10-09","2020-11-07","2020-11-07","2020-11-07","2020-11-07","2020-11-07","2020-11-07","2020-04-03","2020-11-05","2020-04-03","2020-04-03","2020-05-22","2020-05-16","2020-11-06","2020-06-24","2020-07-16","2020-07-16","2020-08-13","2020-07-18","2020-07-20","2020-07-22","2020-07-22","2020-08-13","2020-07-22","2021-06-28","2020-09-02","2020-09-02","2020-10-30","2020-11-12","2020-11-12","2020-11-12","2020-11-19","2021-02-26","2020-05-16","2020-05-16","2020-07-16","2020-07-20","2020-07-16","2020-07-16","2020-09-15","2020-04-03","2020-04-03","2020-04-03","2020-06-19","2020-06-19","2020-07-16","2020-07-20","2020-07-16","2020-07-16","2020-07-20","2020-11-12","2020-07-16","2020-07-16","2020-09-10","2020-11-12","2021-02-26","2020-04-20","2020-05-07","2020-05-07","2020-05-22","2020-05-22","2020-05-22","2020-04-20","2020-10-01","2020-10-01","2020-11-05","2020-11-06","2020-11-05","2020-11-05","2020-11-05","2020-11-05","2020-11-05","2020-11-05","2020-11-05","2020-11-05","2020-11-05","2020-11-05","2020-11-05","2020-11-19","2021-06-16","2020-07-20","2020-07-20","2020-07-20","2020-08-13","2020-09-02","2020-09-30","2021-01-21","2021-04-01","2020-06-16","2020-07-08","2020-07-08","2020-10-16","2020-10-23","2020-10-27","2020-11-27","2020-11-27"],"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":[["","69238126601","OSELTAMIVIR","75MG","10","Select","Select",""],["","00115165901","PROPRANOLOL","10MG","180","Select","Select",""],["","00054327099","FLUTICASONE","50MCG","16","Select","Select",""],["","51224000760","METFORMIN","500MG ER","90","Select","Select",""],["","68462010530","ONDANSETRON","4MG","20","Select","Select",""],["","00185011801","LABETALOL","300MG","-60","Select","Select",""],["","68180072103","AMLODIPINE","10MG","-90","Select","Select",""],["","68462056435","MUPIROCIN","2%","-15","Select","Select",""],["","00781707787","METRONIDAZOL","0.75%VAG","70","Select","Select",""],["","00527169505","BUT\/APAP\/CAF","","-30","Select","Select",""],["","68682010810","NIFEDIPINE","30MG ER","-90","Select","Select",""],["","00536106210","STOOL","100MG","20","Select","Select",""],["","00093314505","CEPHALEXIN","250MG","14","Select","Select",""],["","68462030201","INDOMETHACIN","50MG","12","Select","Select",""],["","69452023420","PROGESTERONE","200MG","-30","Select","Select",""],["","51224002230","AZITHROMYCIN","250MG","8","Select","Select",""],["","67877032105","IBUPROFEN","800MG","-30","Select","Select",""],["","31604002576","MAGNESIUM","400MG","60","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":""}]}]}