{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MICHELE   M OBER","gend":1,"add":"4718 RACE ST","city":"PORTSMOUTH","state":"VA","zip":"23707-9998","dob":"1971-07-23","age":"","mstatus":"","insh":"2271635*01","cliId":"","pno":"757\/646-1493","cno":"757\/646-1493","email":"","ename":"","eno":"","pphy":"JURKO, ROBERT M MD","ppno":"757\/484-5516","pcpadd":"SUITE 15 3101 AMERICAN LEGION","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":23321,"pcpcounty":"","pcpid":127692,"pcpname":"","plan":"OHP","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":["F41.1","R30.0","N20.9","N20.2","N13.8","K76.0","N83.202","K57.30","R10.9","N20.0","N92.6","Z20.828","R19.7","Z01.419","F90.2","F33.2","N13.30","Z88.1","Z88.8","Z91.041","J30.9","F33.1","N13.9","I10.","M19.90","R31.0","Z87.442","Z88.7","Z98.890","Z96.0","Z03.818","F90.1","N20.1","Z86.59","Z87.19","Z87.891","N92.5","J45.909","N93.8","N13.2","Z12.11","E03.9","M62.830","M51.26","Z88.2","Z91.09","M54.5","M51.27","M51.36","M47.816","Z20.822","R68.89","E66.01","E78.2","R73.03"],"date":["2020-04-21","2020-05-06","2020-04-20","2020-04-29","2020-04-29","2020-06-22","2020-04-29","2021-08-07","2020-06-22","2021-08-07","2020-05-21","2020-07-28","2020-12-03","2021-09-30","2021-03-24","2021-11-10","2020-06-22","2021-08-07","2020-06-22","2021-08-07","2020-10-07","2021-02-05","2020-04-29","2020-06-18","2020-06-18","2020-05-06","2020-05-06","2020-05-06","2020-05-06","2020-05-06","2020-12-03","2020-01-06","2020-05-05","2020-05-05","2020-05-05","2020-05-05","2020-05-21","2020-06-18","2021-01-26","2020-08-03","2020-09-25","2021-10-01","2021-06-09","2021-08-07","2021-08-07","2021-08-07","2021-08-07","2021-08-07","2021-10-06","2021-10-06","2021-09-02","2021-09-03","2021-10-01","2021-10-01","2021-10-01"],"priorHcc":["","","","","","","","","","","","","",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":[["","66993059802","AMPHET\/DEXTR","25MG ER","90","Select","Select",""],["","50111064801","FLUOXETINE","20MG","30","Select","Select",""],["","68382013201","TAMSULOSIN","0.4MG","30","Select","Select",""],["","57237007710","ONDANSETRON","4MG ODT","30","Select","Select",""],["","00406051205","OXYCOD\/APAP","5-325MG","12","Select","Select",""],["","13811071910","NITROFURANTN","100MG","14","Select","Select",""],["","57237000511","FLUCONAZOLE","150MG","-1","Select","Select",""],["","65862007701","CIPROFLOXACN","500MG","14","Select","Select",""],["","16729044315","BUPROPN","150MG XL","-30","Select","Select",""],["","00093506105","HYDROXYZ","25MG","-60","Select","Select",""],["","50111043401","TRAZODONE","100MG","30","Select","Select",""],["","54092038701","ADDERALL","20MG","90","Select","Select",""],["","70010075401","METHOCARBAM","500MG","40","Select","Select",""],["","00228203150","ALPRAZOLAM","1MG","60","Select","Select",""],["","16571020210","DICLOFENAC","50MG DR","14","Select","Select",""],["","42571016242","AMOX\/K","875-125","20","Select","Select",""],["","64380080707","IBUPROFEN","800MG","30","Select","Select",""],["","00378623201","CITALOPRAM","20MG","30","Select","Select",""],["","00093314705","CEPHALEXIN","500MG","14","Select","Select",""],["","50111064801","FLUOXETINE ","20MG","-30","Select","Select",""],["","66993059802","AMPHET\/DEXTR ","25MG ER","90","Select","Select",""],["","50111043401","TRAZODONE ","100MG","30","Select","Select",""],["","57237000511","FLUCONAZOLE ","150MG","1","Select","Select",""],["","57237007710","ONDANSETRON ","4MG ODT","30","Select","Select",""],["","68382013201","TAMSULOSIN ","0.4MG","30","Select","Select",""],["","64380080707","IBUPROFEN ","800MG","30","Select","Select",""],["","42571016242","AMOX\/K ","875-125","-20","Select","Select",""],["","00185012201","NITROFURANTN ","100MG","10","Select","Select",""],["","00406051205","OXYCOD\/APAP ","5-325MG","12","Select","Select",""],["","55111012701","CIPROFLOXACN ","500MG","6","Select","Select",""],["","00093314705","CEPHALEXIN ","500MG","14","Select","Select",""],["","00228203150","ALPRAZOLAM ","1MG","60","Select","Select",""],["","10370010150","BUPROPN ","150MG XL","30","Select","Select",""],["","23155050105","HYDROXYZ ","25MG","60","Select","Select",""],["","00378623201","CITALOPRAM ","20MG","30","Select","Select",""],["","54092038901","ADDERALL ","25MG","30","Select","Select",""],["","69238183107","LEVOTHYROXIN ","50MCG","30","Select","Select",""],["","16571020210","DICLOFENAC ","50MG DR","14","Select","Select",""],["","70010075401","METHOCARBAM ","500MG","40","Select","Select",""],["","69238183107","LEVOTHYROXIN","50MCG","30","Select","Select",""],["","67877043003","ARIPIPRAZOLE","2MG","30","Select","Select",""],["","70954005920","PREDNISONE","10MG","-30","Select","Select",""],["","31722088390","ROSUVASTATIN","10MG","90","Select","Select",""],["","55111017915","TIZANIDINE","2MG","90","Select","Select",""],["","00591544210","PREDNISONE ","TAB 10MG","30","Select","Select",""],["","31722088390","ROSUVASTATIN ","TAB 10MG","-90","Select","Select",""],["","55111017915","TIZANIDINE ","TAB 2MG","90","Select","Select",""],["","67877043003","ARIPIPRAZOLE ","TAB 2MG","30","Select","Select",""],["","00378427577","VALACYCLOVIR ","TAB 500MG","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","",""],["Yes","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":""}]}]}