{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KRISTIN DERNBACH","gend":1,"add":"1805 MEHRENS CT","city":"HAMPTON","state":"VA","zip":"23663-9998","dob":"1990-07-05","age":"","mstatus":"","insh":"2226881*01","cliId":"","pno":"252\/562-3529","cno":"252\/562-3529","email":"","ename":"","eno":"","pphy":"ARNOLD, HELEN G DO","ppno":"757\/850-1311","pcpadd":"12715 WARWICK BLVD STE O","pcpcity":"NEWPORT NEWS","pcpstate":"VA","pcpzip":23606,"pcpcounty":"","pcpid":118380,"pcpname":"Commonwealth Family Practice","plan":"OHP","program":"ACA","lob":"Individual","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/269-4406","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R10.2","Z87.891","M22.42","S83.242D","B37.3","F31.4","F41.1","Z20.828","M54.12","F32.9","R55.","F41.9","F31.81","S62.002A","S83.242A","M25.562","G89.29","R10.32","N83.209","Z30.41","R63.5","M76.52","S83.241A","M62.81","M67.52","Z03.818","Z11.59","M76.822","S13.9XXA","Z91.040","Z88.8","M54.2","Z00.00","R13.19","N39.0","R10.30","N83.291","N92.0","Z30.431","E03.9","Z30.46","Z30.09","Z30.011","N89.8","Z97.5","G93.5","Q79.60","Z90.79","Z84.1","N93.9","Z98.51","Q79.62","Z79.899","S62.002S","S66.912A","S61.211A","J01.90","J45.909","J34.89","J01.00","U07.1","J30.1","R42.","Z32.01","O99.519","O99.280","Z53.20"],"date":["2020-02-02","2021-09-04","2020-02-27","2020-02-27","2021-10-10","2021-10-14","2021-10-14","2020-11-28","2020-09-03","2020-09-03","2020-09-03","2020-09-03","2020-09-03","2020-11-19","2020-02-06","2020-03-16","2020-03-16","2021-10-29","2021-01-11","2021-01-11","2021-01-11","2020-08-28","2020-02-20","2020-03-02","2020-03-02","2020-07-06","2020-07-06","2020-08-28","2021-04-10","2021-04-10","2021-04-10","2021-04-10","2020-02-20","2020-07-01","2020-04-28","2020-02-13","2020-02-13","2020-02-13","2020-02-13","2021-10-29","2020-10-08","2020-10-08","2020-10-08","2020-10-08","2020-02-02","2020-02-02","2020-02-02","2020-02-02","2020-02-02","2020-02-02","2020-02-02","2020-10-05","2021-10-29","2020-12-29","2020-12-29","2021-07-02","2021-09-06","2021-10-29","2021-09-06","2021-09-04","2021-09-04","2021-09-03","2021-09-06","2021-10-29","2021-10-29","2021-10-29","2021-10-29"],"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":[["","68180031909","BUPROPN","150MG XL","30","Select","Select",""],["","29300012510","MELOXICAM","15MG","15","Select","Select",""],["","69238183407","LEVOTHYROXIN","100MCG","30","Select","Select",""],["","29300011101","LAMOTRIGINE","25MG","-60","Select","Select",""],["","39328002430","LIDOCAINE","4%","30","Select","Select",""],["","00093506105","HYDROXYZ","25MG","30","Select","Select",""],["","45802026337","CLINDAMYCIN","1%","60","Select","Select",""],["","00378808345","TRETINOIN","0.05%","45","Select","Select",""],["","00115703301","FLUDROCORT","0.1MG","30","Select","Select",""],["","49884051303","MINOCYCLINE","100MG","30","Select","Select",""],["","69097052444","DICLOFENAC","1%","-300","Select","Select",""],["","00228202996","ALPRAZOLAM","0.5MG","30","Select","Select",""],["","70010077001","METHOCARBAM","750MG","10","Select","Select",""],["","65862042005","SMZ\/TMP","800-160","10","Select","Select",""],["","57237000511","FLUCONAZOLE","150MG","2","Select","Select",""],["","68382091634","METHYLPRED","4MG","-21","Select","Select",""],["","51991000633","DESVENLAFAX","25MG ER","30","Select","Select",""],["","57237007710","ONDANSETRON","4MG ODT","30","Select","Select",""],["","00430042014","LO","1\/10\/10","84","Select","Select",""],["","64380080807","IBUPROFEN","600MG","30","Select","Select",""],["","55111018015","TIZANIDINE","4MG","30","Select","Select",""],["","45802088094","NYSTAT\/TRIAM","","30","Select","Select",""],["","49884051303","MINOCYCLINE ","100MG","30","Select","Select",""],["","39328002430","LIDOCAINE ","4%","30","Select","Select",""],["","68180031909","BUPROPN ","150MG XL","30","Select","Select",""],["","29300012510","MELOXICAM ","15MG","15","Select","Select",""],["","70010077001","METHOCARBAM ","750MG","10","Select","Select",""],["","69238183407","LEVOTHYROXIN ","100MCG","30","Select","Select",""],["","29300011101","LAMOTRIGINE ","25MG","-60","Select","Select",""],["","00115703301","FLUDROCORT ","0.1MG","30","Select","Select",""],["","00093506105","HYDROXYZ ","25MG","-30","Select","Select",""],["","00378808345","TRETINOIN ","0.05%","45","Select","Select",""],["","45802026337","CLINDAMYCIN ","1%","-60","Select","Select",""],["","69097052444","DICLOFENAC ","1%","300","Select","Select",""],["","00228202996","ALPRAZOLAM ","0.5MG","30","Select","Select",""],["","65862042005","SMZ\/TMP ","800-160","-10","Select","Select",""],["","57237000511","FLUCONAZOLE ","150MG","2","Select","Select",""],["","68382091634","METHYLPRED ","4MG","-21","Select","Select",""],["","64380080807","IBUPROFEN ","600MG","-30","Select","Select",""],["","55111018015","TIZANIDINE ","4MG","30","Select","Select",""],["","00430042014","LO ","1\/10\/10","84","Select","Select",""],["","51991031133","DESVENLAFAX ","50MG ER","-30","Select","Select",""],["","57237007710","ONDANSETRON ","4MG ODT","-30","Select","Select",""],["","45802088094","NYSTAT\/TRIAM ","","30","Select","Select",""],["","00781185220","AMOX\/K ","875-125","20","Select","Select",""],["","00781185220","AMOX\/K","875-125","20","Select","Select",""],["","00591544305","PREDNISONE","20MG","10","Select","Select",""],["","00143211250","DOXYCYCL","100MG","14","Select","Select",""],["","51672130200","TERCONAZOLE","0.80%","-20","Select","Select",""],["","00591544305","PREDNISONE ","TAB 20MG","10","Select","Select",""],["","00143211250","DOXYCYCL ","TAB 100MG","14","Select","Select",""],["","51672130200","TERCONAZOLE ","CRE 0.008","-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","",""],["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":""}]}]}