{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SHAWNA   R SKOCICH","gend":1,"add":"1413 SAMPSON LN","city":"VIRGINIA BEACH","state":"VA","zip":"23462-9998","dob":"1972-12-22","age":"","mstatus":"","insh":"2471191*01","cliId":"","pno":"757\/560-8931","cno":"757\/560-8931","email":"","ename":"","eno":"","pphy":"POST, CHRISTOPHER MD","ppno":"804\/968-5700","pcpadd":"SUITE 100 5000 COX ROAD","pcpcity":"GLEN ALLEN","pcpstate":"VA","pcpzip":23060,"pcpcounty":"","pcpid":125385,"pcpname":"","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"757\/351-1105","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":["R59.0","E04.1","H25.812","J01.90","J30.89","Z20.828","H20.019","R22.1","E66.9","H25.13","D89.89","R21.","H04.129","R68.2","M79.10","H30.91","H30.92","E07.9","Z96.1","F90.0","F43.23","H20.9","H35.353","H04.123","Z03.818","Z11.59","R05.","H26.9","H21.542","G47.33","H25.811","R13.10","K21.9","R09.89","E06.3","M54.5","M54.16","H25.813","Z00.00","E78.00","Z12.39","R51.9","H20.13","G44.209","H43.811","H43.812"],"date":["2020-10-30","2020-12-08","2020-11-04","2021-04-13","2021-04-13","2021-04-13","2021-04-21","2021-04-21","2021-04-21","2020-03-03","2020-09-21","2020-10-20","2020-10-20","2020-10-20","2020-09-21","2021-10-28","2021-10-28","2021-10-28","2021-10-28","2020-03-04","2020-03-04","2021-03-03","2020-09-25","2020-06-30","2020-08-03","2020-08-03","2021-04-21","2020-12-09","2020-11-04","2021-02-25","2020-12-09","2020-12-08","2020-12-08","2020-12-08","2020-12-08","2021-07-10","2020-03-12","2020-09-25","2021-03-19","2020-12-04","2020-12-04","2020-12-04","2021-03-19","2020-10-10","2021-10-28","2021-10-28"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}},{"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":[["","00406889301","AMPHET\/DEXTR","20MG","-60","Select","Select",""],["","70010077001","METHOCARBAM","750MG","90","Select","Select",""],["","00603459315","METHYLPRED","4MG","21","Select","Select",""],["","60758011905","PREDNISOLONE","1% OP","5","Select","Select",""],["","00143924920","AMOX\/K","875-125","-20","Select","Select",""],["","66993001968","ALBUTEROL","HFA","18","Select","Select",""],["","62542030104","HYD","10-8\/5ML","100","Select","Select",""],["","10702025301","BUT\/APAP\/CAF","","30","Select","Select",""],["","31722094101","HYDROCO\/APAP","5-325MG","20","Select","Select",""],["","00173068220","VENTOLIN","","18","Select","Select",""],["","55111015901","OMEPRAZOLE","40MG","30","Select","Select",""],["","55111018015","TIZANIDINE","4MG","30","Select","Select",""],["","67877032105","IBUPROFEN","800MG","90","Select","Select",""],["","24208060203","PROLENSA","0.07%","3","Select","Select",""],["","31722095801","BENZONATATE","200MG","30","Select","Select",""],["","59267100001","PFIZER","COVID-19","0","Select","Select",""],["","60432026415","FLUTICASONE","50MCG","16","Select","Select",""],["","00172392660","DIAZEPAM","5MG","12","Select","Select",""],["","69315012701","FOLIC","1000MCG","-30","Select","Select",""],["","45802006435","TRIAMCINOLON","0.10%","15","Select","Select",""],["","17478071310","OFLOXACIN","0.3% OP","5","Select","Select",""],["","00054455015","METHOTREXATE","2.5MG","-24","Select","Select",""],["","11822070538","ALLERGY","10MG","30","Select","Select",""],["","13107007301","AMPHET\/DEXTR ","20MG","60","Select","Select",""],["","70010077001","METHOCARBAM ","750MG","-90","Select","Select",""],["","67877032105","IBUPROFEN ","800MG","90","Select","Select",""],["","31722094101","HYDROCO\/APAP ","5-325MG","-30","Select","Select",""],["","00603459315","METHYLPRED ","4MG","-21","Select","Select",""],["","60758011905","PREDNISOLONE ","1% OP","5","Select","Select",""],["","00143924920","AMOX\/K ","875-125","14","Select","Select",""],["","62542030104","HYD ","10-8\/5ML","100","Select","Select",""],["","66993001968","ALBUTEROL ","HFA","18","Select","Select",""],["","00173068220","VENTOLIN ","","18","Select","Select",""],["","45802006435","TRIAMCINOLON ","0.10%","15","Select","Select",""],["","10702025301","BUT\/APAP\/CAF ","","30","Select","Select",""],["","24208060203","PROLENSA ","0.07%","3","Select","Select",""],["","17478071310","OFLOXACIN ","0.3% OP","5","Select","Select",""],["","55111015901","OMEPRAZOLE ","40MG","30","Select","Select",""],["","55111018015","TIZANIDINE ","4MG","30","Select","Select",""],["","60432026415","FLUTICASONE ","50MCG","-16","Select","Select",""],["","11822060539","ALLERGY ","10MG","30","Select","Select",""],["","31722095801","BENZONATATE ","200MG","30","Select","Select",""],["","00054455015","METHOTREXATE ","2.5MG","16","Select","Select",""],["","69315012701","FOLIC ","1000MCG","30","Select","Select",""],["","59267100001","PFIZER ","COVID-19","0","Select","Select",""],["","00172392660","DIAZEPAM ","5MG","12","Select","Select",""],["","61314012605","KETOROLAC","0.50%","5","Select","Select",""],["","61314003002","DORZOL\/TIMOL","22.3-6.8","10","Select","Select",""],["","61314003002","DORZOL\/TIMOL ","SOL 22.3-6.8","10","Select","Select",""],["","61314012605","KETOROLAC ","SOL 0.005","5","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":""}]}]}