{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ELISE   C MCPHEE","gend":1,"add":"8221 WEDGEWOOD DR","city":"NORFOLK","state":"VA","zip":"23518-9998","dob":"2002-05-29","age":"","mstatus":"","insh":"2246825*04","cliId":"","pno":"757\/412-9561","cno":"757\/412-9561","email":"","ename":"","eno":"","pphy":"TOLAND, JOSEPH MD","ppno":"757\/440-0719","pcpadd":"924 W LITTLE CREEK ROAD","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23505,"pcpcounty":"","pcpid":100182,"pcpname":"","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/440-7981","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F43.10","Z79.899","F91.3","F60.3","F19.90","Z13.1","Z23.","T42.1X2A","T43.212A","Z91.5","F12.90","S09.93XA","Z20.828","R11.2","R05.","F41.1","Z20.822","K21.9","F31.9","F32.9","R45.851","Z74.3","F91.8","H00.19","Z11.7","T50.901A","F41.8","S41.112A","T65.91XA","F43.25","F90.9","N13.2","Z00.00","T30.0","L70.9","S40.812A","F41.9","X78.8XXA","F31.60","F90.2"],"date":["2020-03-04","2020-07-21","2020-03-16","2020-06-10","2020-03-04","2020-03-05","2020-10-07","2020-03-14","2020-03-14","2020-03-14","2020-03-14","2020-09-18","2021-01-25","2021-06-17","2021-02-12","2021-02-12","2021-02-12","2021-03-04","2021-03-04","2021-03-04","2020-03-16","2020-02-11","2020-03-16","2020-10-19","2020-10-21","2020-03-14","2020-02-10","2020-02-10","2020-03-16","2020-03-16","2020-03-16","2021-06-17","2020-10-07","2020-10-07","2020-10-07","2020-03-14","2020-03-14","2020-02-10","2020-02-11","2020-02-11"],"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":[["","00093005405","BUSPIRONE","10MG","60","Select","Select",""],["","60505392801","GUANFACINE","2MG ER","30","Select","Select",""],["","68382080601","TRAZODONE","100MG","30","Select","Select",""],["","66993068330","OLANZAPINE","10MG","60","Select","Select",""],["","51991029201","OXCARBAZEPIN","150MG","30","Select","Select",""],["","63402030430","LATUDA","40MG","30","Select","Select",""],["","00185061501","HYDROXYZ","50MG","90","Select","Select",""],["","00603548321","PROPRANOLOL","20MG","60","Select","Select",""],["","43547028211","ESCITALOPRAM","20MG","30","Select","Select",""],["","47469006955","","","30","Select","Select",""],["","13668021730","ARIPIPRAZOLE","5MG","30","Select","Select",""],["","17478007035","ERYTHROMYCIN","OP","4","Select","Select",""],["","68382004001","PROMETHAZINE","12.5MG","12","Select","Select",""],["","68645014059","FAMOTIDINE","20MG","60","Select","Select",""],["","59762013108","SILVER","1%","85","Select","Select",""],["","00406051201","OXYCOD\/APAP","5-325MG","10","Select","Select",""],["","55111015330","ONDANSETRON","4MG","20","Select","Select",""],["","67877021905","CEPHALEXIN","500MG","-20","Select","Select",""],["","00781286810","OMEPRAZOLE","20MG","30","Select","Select",""],["","42806071401","BENZONATATE","100MG","30","Select","Select",""],["","66993068330","OLANZAPINE ","10MG","60","Select","Select",""],["","60505392801","GUANFACINE ","2MG ER","30","Select","Select",""],["","68382080601","TRAZODONE ","100MG","30","Select","Select",""],["","00093005405","BUSPIRONE ","10MG","60","Select","Select",""],["","51991029201","OXCARBAZEPIN ","150MG","30","Select","Select",""],["","63402030430","LATUDA ","40MG","30","Select","Select",""],["","00185061501","HYDROXYZ ","50MG","90","Select","Select",""],["","00603548321","PROPRANOLOL ","20MG","60","Select","Select",""],["","43547028111","ESCITALOPRAM ","10MG","30","Select","Select",""],["","13668021730","ARIPIPRAZOLE ","5MG","-30","Select","Select",""],["","59762013108","SILVER ","1%","-85","Select","Select",""],["","67877021905","CEPHALEXIN ","500MG","20","Select","Select",""],["","17478007035","ERYTHROMYCIN ","OP","4","Select","Select",""],["","68382004001","PROMETHAZINE ","12.5MG","12","Select","Select",""],["","42806071401","BENZONATATE ","100MG","30","Select","Select",""],["","00781286810","OMEPRAZOLE ","20MG","30","Select","Select",""],["","55111015330","ONDANSETRON ","4MG","20","Select","Select",""],["","68645014059","FAMOTIDINE ","20MG","60","Select","Select",""],["","00406051201","OXYCOD\/APAP ","5-325MG","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":""}]}]}