{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JANA   L EVANS","gend":1,"add":"1528 CONDOR AVE","city":"NORFOLK","state":"VA","zip":"23518-9998","dob":"1985-08-19","age":"","mstatus":"","insh":"2278845*02","cliId":"","pno":"757\/692-5786","cno":"757\/692-5786","email":"","ename":"","eno":"","pphy":"KIRKLAND, C STOKES MD","ppno":"757\/622-6520","pcpadd":"STE 1 425 W 20TH ST","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23517,"pcpcounty":"","pcpid":110772,"pcpname":"","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"757\/202-3731","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/622-7205","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M50.123","M47.812","J06.9","R35.8","R55.","R00.2","R42.","N76.0","Z30.9","N92.0","R51.9","Z32.02","Z30.430","Z71.89","S33.9XXA","M50.222","M48.02","M99.81","M25.511","H66.002","M54.2","G56.00","M54.12","M25.519","E34.9","N92.6","R68.82","L65.9","N94.3","R45.4","E55.9","M50.10","Z12.4","R53.83","R84.9","E53.8","E78.5","R73.09","H66.93","J30.9","J32.9","H66.90","Z01.411","N89.8","S01.81XA","Z85.118","Z91.040","G43.909","Z11.52"],"date":["2020-06-26","2020-06-26","2020-07-22","2020-08-17","2021-09-04","2020-08-17","2021-08-27","2021-02-19","2021-02-25","2021-02-25","2021-08-27","2021-02-25","2021-02-25","2020-05-13","2020-11-21","2020-05-08","2020-05-08","2020-05-08","2020-05-08","2020-02-14","2020-08-17","2020-04-22","2020-04-22","2020-04-22","2020-02-14","2020-02-14","2020-02-14","2020-02-14","2020-02-14","2020-02-14","2021-07-19","2020-05-08","2021-02-19","2021-09-04","2021-07-19","2021-07-19","2021-07-19","2021-07-19","2020-02-18","2020-03-26","2020-03-26","2020-03-26","2021-02-19","2021-02-19","2021-08-27","2021-08-27","2021-08-27","2021-09-04","2021-10-28"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",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":[["","00378064110","PREDNISONE ","10MG","15","Select","Select",""],["","11534018701","BUT\/APAP\/CAF ","","30","Select","Select",""],["","65862050320","AMOX\/K ","875-125","20","Select","Select",""],["","13107008405","LORAZEPAM ","1MG","30","Select","Select",""],["","65162044110","MECLIZINE ","12.5MG","30","Select","Select",""],["","63304069301","CLINDAMYCIN ","300MG","20","Select","Select",""],["","51991081403","AZELASTINE ","0.10%","30","Select","Select",""],["","00093742698","MONTELUKAST ","10MG","90","Select","Select",""],["","69097084615","CYCLOBENZAPR ","10MG","15","Select","Select",""],["","16571020106","DICLOFENAC ","75MG DR","60","Select","Select",""],["","60505025203","TIZANIDINE ","4MG","30","Select","Select",""],["","69097094312","GABAPENTIN ","300MG","90","Select","Select",""],["","00006911731","SINGULAIR ","10MG","90","Select","Select",""],["","47781030301","NITROFURANTN ","100MG","14","Select","Select",""],["","43547030203","ARIPIPRAZOLE ","2MG","30","Select","Select",""],["","71093014105","METHOCARBAM ","750MG","30","Select","Select",""],["","68180086473","BLISOVI ","FE 1\/20","-84","Select","Select",""],["","50111033401","METRONIDAZOL ","500MG","14","Select","Select",""],["","70710113908","FLUCONAZOLE ","150MG","2","Select","Select",""],["","59779046378","CVS ","4MG","30","Select","Select",""],["","55111029236","SUMATRIPTAN ","50MG","9","Select","Select",""],["","68180016013","AZITHROMYCIN ","250MG","6","Select","Select",""],["","00093767902","ETONOGESTREL ","ETHY EST","3","Select","Select",""],["","68382092286","ELETRIPTAN ","20MG","9","Select","Select",""],["","67877026118","RIZATRIPTAN ","5MG","9","Select","Select",""],["","67877057305","BENZONATATE ","100MG","90","Select","Select",""],["","70700012185","TRI-ESTARYLL ","","84","Select","Select",""],["","00002143611","EMGALITY ","120MG\/ML","3","Select","Select",""],["","65862050320","AMOX\/K","875-125","20","Select","Select",""],["","63304069301","CLINDAMYCIN","300MG","20","Select","Select",""],["","00378064110","PREDNISONE","10MG","15","Select","Select",""],["","11534018701","BUT\/APAP\/CAF","","30","Select","Select",""],["","13107008405","LORAZEPAM","1MG","30","Select","Select",""],["","00536117801","MECLIZINE","12.5MG","30","Select","Select",""],["","51991081403","AZELASTINE","0.10%","30","Select","Select",""],["","00093742698","MONTELUKAST","10MG","90","Select","Select",""],["","69097084615","CYCLOBENZAPR","10MG","15","Select","Select",""],["","60505025203","TIZANIDINE","4MG","30","Select","Select",""],["","16571020106","DICLOFENAC","75MG DR","60","Select","Select",""],["","69097094312","GABAPENTIN","300MG","90","Select","Select",""],["","00006911731","SINGULAIR","10MG","90","Select","Select",""],["","47781030301","NITROFURANTN","100MG","14","Select","Select",""],["","43547030203","ARIPIPRAZOLE","2MG","30","Select","Select",""],["","71093014105","METHOCARBAM","750MG","30","Select","Select",""],["","68180086473","BLISOVI","FE 1\/20","84","Select","Select",""],["","50111033401","METRONIDAZOL","500MG","14","Select","Select",""],["","70710113908","FLUCONAZOLE","150MG","2","Select","Select",""],["","59779046378","CVS","4MG","30","Select","Select",""],["","68180016013","AZITHROMYCIN","250MG","6","Select","Select",""],["","68382092286","ELETRIPTAN","20MG","9","Select","Select",""],["","55111029236","SUMATRIPTAN","50MG","9","Select","Select",""],["","00093767902","ETONOGESTREL","ETHY EST","3","Select","Select",""],["","67877026118","RIZATRIPTAN","5MG","9","Select","Select",""],["","00002143611","EMGALITY","120MG\/ML","3","Select","Select",""],["","67877057305","BENZONATATE","100MG","90","Select","Select",""],["","70700012185","TRI-ESTARYLL","","84","Select","Select",""],["","51525590101","CARISOPRODOL","250MG","30","Select","Select",""],["","00186037020","SYMBICORT","160-4.5","-10","Select","Select",""],["","00310737020","BUDES\/FORMOT","160-4.5","10","Select","Select",""],["","00186037020","SYMBICORT ","AER 160-4.5","10","Select","Select",""],["","00310737020","BUDES\/FORMOT ","AER 160-4.5","10","Select","Select",""],["","51525590101","CARISOPRODOL ","TAB 250MG","30","Select","Select",""],["","60842002301","AUVI-Q ","INJ 0.3MG","2","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":""}]}]}