{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KEVIN KEENE-JOHNSON","gend":0,"add":"304 MARSH LOOP","city":"HAMPTON","state":"VA","zip":"23666-9998","dob":"1993-05-09","age":"","mstatus":"","insh":"2315611*01","cliId":"","pno":"757\/593-6711","cno":"757\/593-6711","email":"","ename":"","eno":"","pphy":"THOMPSON, RODNEY MD","ppno":"804\/968-5700","pcpadd":"5000 COX ROAD SUITE 100","pcpcity":"GLEN ALLEN","pcpstate":"VA","pcpzip":23060,"pcpcounty":"","pcpid":178713,"pcpname":"","plan":"OHP","program":"ACA","lob":"Individual","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/968-5739","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R22.31","Z79.899","J45.909","Z79.1","A53.9","F33.1","F41.9","K64.8","G47.9","J45.20","Z00.00","F90.2","F32.9","F43.10","Z72.52","Z11.3","K64.1","K92.1","R53.83","L21.9","L70.0","K13.0","Z71.9","L74.510","Z28.21","R68.82","G47.8","G47.30","R06.83","G47.19","Z68.1","Z11.4","F44.1","F41.1"],"date":["2020-09-15","2020-09-15","2020-09-15","2020-09-15","2020-10-07","2021-11-08","2021-04-01","2020-12-24","2021-02-16","2020-09-17","2020-09-17","2021-04-01","2021-04-01","2021-04-01","2021-06-08","2021-06-08","2020-12-09","2020-12-09","2021-02-10","2021-02-04","2021-02-04","2021-02-04","2021-02-04","2020-08-06","2020-08-06","2021-02-10","2021-02-16","2021-02-16","2021-02-16","2021-02-16","2021-02-16","2021-06-08","2021-11-08","2021-05-04"],"priorHcc":["","","","","",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":[["","45802046564","KETOCONAZOLE","2%","120","Select","Select",""],["","61958070101","TRUVADA","200-300","30","Select","Select",""],["","43547028111","ESCITALOPRAM","10MG","90","Select","Select",""],["","21922000201","CLINDAMYCIN","1%","60","Select","Select",""],["","00093760756","EMTR\/TENOFOV","200-300","30","Select","Select",""],["","65162019050","NAPROXEN","500MG","20","Select","Select",""],["","50742030450","CLOBETASOL","0.05%","50","Select","Select",""],["","00096070735","DRYSOL","20%","35","Select","Select",""],["","42494030112","HYDROCORT","25MG","7","Select","Select",""],["","00472011745","TRETINOIN","0.03%","45","Select","Select",""],["","43386002606","FLUOCINONIDE","0.05%","60","Select","Select",""],["","68180012202","CEPHALEXIN","500MG","40","Select","Select",""],["","00093317431","ALBUTEROL","HFA","8","Select","Select",""],["","00456202001","LEXAPRO","20MG","30","Select","Select",""],["","88888888887","DMR","","1","Select","Select",""],["","00472011745","TRETINOIN ","0.03%","45","Select","Select",""],["","00096070735","DRYSOL ","20%","35","Select","Select",""],["","21922000201","CLINDAMYCIN ","1%","60","Select","Select",""],["","43386002606","FLUOCINONIDE ","0.05%","60","Select","Select",""],["","00093317431","ALBUTEROL ","HFA","8","Select","Select",""],["","65162019050","NAPROXEN ","500MG","20","Select","Select",""],["","68180012202","CEPHALEXIN ","500MG","40","Select","Select",""],["","61958070101","TRUVADA ","200-300","30","Select","Select",""],["","43547028111","ESCITALOPRAM ","10MG","30","Select","Select",""],["","00093760756","EMTR\/TENOFOV ","200-300","30","Select","Select",""],["","00456202001","LEXAPRO ","20MG","30","Select","Select",""],["","50742030450","CLOBETASOL ","0.05%","50","Select","Select",""],["","45802046564","KETOCONAZOLE ","2%","120","Select","Select",""],["","42494030112","HYDROCORT ","25MG","7","Select","Select",""],["","88888888887","DMR ","","1","Select","Select",""],["","00781261305","AMOXICILLIN ","500MG","21","Select","Select",""],["","00781261305","AMOXICILLIN","500MG","21","Select","Select",""],["","31722000490","VENLAFAXINE","150MG ER","30","Select","Select",""],["","13668021730","ARIPIPRAZOLE","5MG","30","Select","Select",""],["","31722000490","VENLAFAXINE ","CAP 150MG ER","30","Select","Select",""],["","13668021730","ARIPIPRAZOLE ","TAB 5MG","30","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":""}]}]}