{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SYBIL   L SPURGEON","gend":1,"add":"128 W BELVEDERE ROAD","city":"NORFOLK","state":"VA","zip":"23505-9998","dob":"1974-03-09","age":"","mstatus":"","insh":"2299776*02","cliId":"","pno":"757\/619-5159","cno":"757\/619-5159","email":"","ename":"","eno":"","pphy":"LAPLACE, LEA SOLINAP MD","ppno":"757\/623-6072","pcpadd":"426 E FREEMASON ST","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23510,"pcpcounty":"","pcpid":100004,"pcpname":"Associates in Primary Care, PC","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/623-9748","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G44.89","Q28.2","Z12.11","Z80.0","K64.8","L82.1","L90.5","L81.4","D18.00","Z12.4","Z11.51","N93.8","Z12.31","Z20.828","Z00.00","G44.209","Z82.62","G43.101","R94.6","Z23."],"date":["2021-11-17","2020-11-11","2021-03-17","2021-03-17","2021-03-17","2021-03-24","2021-03-24","2021-03-24","2021-03-24","2020-08-14","2020-08-14","2021-04-14","2021-08-25","2020-12-19","2020-08-12","2020-08-12","2020-08-12","2020-08-12","2020-08-12","2020-08-12"],"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":[["","68462013279","NORETH\/ETHIN","20-Jan","-84","Select","Select",""],["","33342009341","RIZATRIPTAN","5MG ODT","9","Select","Select",""],["","57237007710","ONDANSETRON","4MG ODT","20","Select","Select",""],["","68382013905","TOPIRAMATE","50MG","145","Select","Select",""],["","57896044101","BISACODYL","5MG EC","4","Select","Select",""],["","65649040001","PLENVU","","3","Select","Select",""],["","51862017901","BUT\/APAP\/CAF","","40","Select","Select",""],["","00228277811","PROPRANOLOL","60MG ER","90","Select","Select",""],["","00713052612","PROMETHEGAN","25MG","20","Select","Select",""],["","65862092205","TRAMADL\/APAP","37.5-325","40","Select","Select",""],["","51862000701","MICROGESTIN","20-Jan","63","Select","Select",""],["","59762005601","MEDROXYPR","10MG","7","Select","Select",""],["","58160088552","FLUARIX","2020-21","0","Select","Select",""],["","51862000701","MICROGESTIN ","20-Jan","-63","Select","Select",""],["","57237008563","RIZATRIPTAN ","5MG ODT","9","Select","Select",""],["","68462013279","NORETH\/ETHIN ","20-Jan","63","Select","Select",""],["","57237007710","ONDANSETRON ","4MG ODT","-20","Select","Select",""],["","51862017901","BUT\/APAP\/CAF ","","40","Select","Select",""],["","00713052612","PROMETHEGAN ","25MG","20","Select","Select",""],["","65649040001","PLENVU ","","3","Select","Select",""],["","57896044101","BISACODYL ","5MG EC","4","Select","Select",""],["","68382013905","TOPIRAMATE ","50MG","145","Select","Select",""],["","58160088552","FLUARIX ","2020-21","0","Select","Select",""],["","00228277811","PROPRANOLOL ","60MG ER","90","Select","Select",""],["","65862092205","TRAMADL\/APAP ","37.5-325","40","Select","Select",""],["","59762005601","MEDROXYPR ","10MG","7","Select","Select",""],["","00378808245","TRETINOIN","0.03%","45","Select","Select",""],["","59267100001","PFIZER","COVID-19","0","Select","Select",""],["","59267100001","PFIZER ","INJ COVID-19","0","Select","Select",""],["","70756020111","AMITRIPTYLIN ","TAB 10MG","-30","Select","Select",""],["","00378808245","TRETINOIN ","CRE 0.00025","45","Select","Select",""],["","42806040021","METHYLPRED ","TAB 4MG","21","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":""}]}]}