{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KOURTNEY   M WARR","gend":1,"add":"129 SONGBIRD TRL","city":"YORKTOWN","state":"VA","zip":"23692-9998","dob":"1997-05-23","age":"","mstatus":"","insh":"2326549*03","cliId":"","pno":"757\/869-5872","cno":"757\/869-5872","email":"","ename":"","eno":"","pphy":"PHILLIPS, CHARLES K MD","ppno":"757\/594-4111","pcpadd":"12 BRUTON AVENUE","pcpcity":"NEWPORT NEWS","pcpstate":"VA","pcpzip":23601,"pcpcounty":"","pcpid":118380,"pcpname":"Bruton Avenue Family Practice","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/594-4115","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E46.","K31.84","E03.9","R10.9","R11.0","K90.9","R39.9","E89.0","F43.23","G89.29","E05.00","F41.9","Z93.4","Z79.891","Z51.81","N32.81","R23.2","G44.201","Z11.1","Z01.419","R10.2","B00.1","R35.0","N39.41"],"date":["2021-10-23","2021-10-23","2021-09-14","2021-09-14","2020-12-15","2020-12-15","2020-12-20","2021-04-06","2021-06-24","2021-09-14","2021-04-28","2021-04-28","2021-09-14","2021-04-28","2021-04-28","2021-01-13","2021-07-13","2021-06-24","2021-07-27","2021-09-02","2021-09-13","2021-09-14","2021-09-29","2021-09-29"],"priorHcc":[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":[["","00054062263","DICYCLOMINE","10MG\/5ML","1200","Select","Select",""],["","17478071130","LIDOCAINE","2% JELLY","30","Select","Select",""],["","16714079701","SUMATRIPTAN","50MG","-9","Select","Select",""],["","00456045901","ARMOUR","60MG","-30","Select","Select",""],["","00093317431","ALBUTEROL","HFA","8","Select","Select",""],["","65162062710","TRAMADOL","50MG","14","Select","Select",""],["","70461032003","FLUCLVX","2020-21","0","Select","Select",""],["","00430042014","LO","1\/10\/10","28","Select","Select",""],["","42192033001","NP","60MG","30","Select","Select",""],["","16714040604","LARIN","20-Jan","28","Select","Select",""],["","65862037401","ESCITALOPRAM","10MG","30","Select","Select",""],["","00093412773","PENICILLN","250\/5ML","400","Select","Select",""],["","00469260130","MYRBETRIQ","25MG","30","Select","Select",""],["","65862049647","SMZ-TMP","200-40\/5","-120","Select","Select",""],["","00006482700","VARIVAX","","1","Select","Select",""],["","00006468100","M-M-R","","1","Select","Select",""],["","70954000510","OXYBUTYNIN","5MG","60","Select","Select",""],["","00832046530","NYAMYC","100000","30","Select","Select",""],["","00135019902","CITRUCEL","500MG","180","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","00430042014","LO ","1\/10\/10","28","Select","Select",""],["","00054062263","DICYCLOMINE ","10MG\/5ML","1200","Select","Select",""],["","16714079701","SUMATRIPTAN ","50MG","9","Select","Select",""],["","00456045901","ARMOUR ","60MG","30","Select","Select",""],["","16714040604","LARIN ","20-Jan","28","Select","Select",""],["","00006482700","VARIVAX ","","1","Select","Select",""],["","70461032003","FLUCLVX ","2020-21","0","Select","Select",""],["","17478071130","LIDOCAINE ","2% JELLY","30","Select","Select",""],["","42192033101","NP ","90MG","30","Select","Select",""],["","65162062710","TRAMADOL ","50MG","60","Select","Select",""],["","65862049647","SMZ-TMP ","200-40\/5","-120","Select","Select",""],["","00469260130","MYRBETRIQ ","25MG","30","Select","Select",""],["","00135019902","CITRUCEL ","500MG","180","Select","Select",""],["","00093317431","ALBUTEROL ","HFA","8","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","65862037401","ESCITALOPRAM ","10MG","30","Select","Select",""],["","00832046530","NYAMYC ","100000","30","Select","Select",""],["","00093412773","PENICILLN ","250\/5ML","-400","Select","Select",""],["","00006468100","M-M-R ","","1","Select","Select",""],["","70954000510","OXYBUTYNIN ","5MG","60","Select","Select",""],["","49281042150","FLUZONE","2021-22","0","Select","Select",""],["","00378728353","NORETH\/ETHIN","FE 1\/20","28","Select","Select",""],["","65862044930","VALACYCLOVIR","1GM","20","Select","Select",""],["","65862077885","TRI-LO-MILI","","28","Select","Select",""],["","49281042150","FLUZONE ","INJ 2021-22","0","Select","Select",""],["","65862077885","TRI-LO-MILI ","TAB ","28","Select","Select",""],["","00378728353","NORETH\/ETHIN ","TAB FE 1\/20","28","Select","Select",""],["","65862044930","VALACYCLOVIR ","TAB 1GM","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":[[["Yes","Select","","","","","Select","",""],["Yes","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":""}]}]}