{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BRENDA   M COHOON","gend":1,"add":"805 GABLE WAY","city":"VIRGINIA BEACH","state":"VA","zip":"23455-9998","dob":"1964-09-18","age":"","mstatus":"","insh":"3022072*01","cliId":"","pno":"757\/647-7553","cno":"757\/647-7553","email":"","ename":"","eno":"","pphy":"BUMANGLAG, LEILA MD","ppno":"757\/738-1200","pcpadd":"155 KINGSLEY LN SUITE 400","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23505,"pcpcounty":"","pcpid":208987,"pcpname":"DEPAUL MEDICAL ASSOCIATES","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"757\/490-4734","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/489-6469","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["A41.9","J18.9","J96.01","J44.1","J44.0","J20.9","F17.210","Z79.899","Z88.8","Z20.828","I10.","K21.9","E66.9","Z68.33","F17.200","R10.33","E78.1","R73.03","Z12.11","Z13.31","R06.2","E78.5","R06.02","R07.9","Z12.31","E78.2","Z68.34","Z11.59","Z03.818","Z01.419","R05.","R06.00","R09.02","Z23.","Z86.010","R22.1","J30.9","E55.9","R22.0","E04.1","M50.21"],"date":["2020-10-30","2020-10-30","2020-10-30","2020-10-27","2020-10-27","2020-10-27","2020-10-28","2020-10-27","2020-10-27","2021-09-20","2021-09-28","2021-05-20","2020-10-30","2020-11-23","2020-11-23","2020-10-16","2020-10-16","2021-10-05","2020-08-31","2020-08-31","2020-10-27","2020-10-27","2020-10-27","2020-10-27","2021-11-22","2021-09-28","2020-10-19","2020-08-12","2020-08-12","2020-11-23","2020-10-27","2020-10-27","2020-10-27","2020-11-23","2021-05-20","2021-10-26","2021-09-28","2021-09-28","2021-10-05","2021-10-05","2021-10-26"],"priorHcc":["","","","","","","","","","",null,"","","","","","",null,"","","","","","",null,null,"","","","","","","","","",null,null,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":[["","49884066109","CANDESARTAN","32MG","90","Select","Select",""],["","00378235193","ESOMEPRA","40MG DR","30","Select","Select",""],["","65862019105","CYCLOBENZAPR","10MG","90","Select","Select",""],["","00173068220","VENTOLIN","","18","Select","Select",""],["","00597007541","SPIRIVA","HANDIHLR","30","Select","Select",""],["","60505257909","ATORVASTATIN","20MG","-90","Select","Select",""],["","65862064163","AZITHROMYCIN","250MG","3","Select","Select",""],["","68180096301","ALBUTEROL","HFA","8","Select","Select",""],["","59746017310","PREDNISONE","10MG","43","Select","Select",""],["","49884066109","CANDESARTAN ","32MG","90","Select","Select",""],["","00378235193","ESOMEPRA ","40MG DR","30","Select","Select",""],["","65862019105","CYCLOBENZAPR ","10MG","90","Select","Select",""],["","60505257909","ATORVASTATIN ","20MG","90","Select","Select",""],["","50111078810","AZITHROMYCIN ","500MG","-2","Select","Select",""],["","00597007541","SPIRIVA ","HANDIHLR","30","Select","Select",""],["","00173068220","VENTOLIN ","","18","Select","Select",""],["","59746017310","PREDNISONE ","10MG","43","Select","Select",""],["","68180096301","ALBUTEROL ","HFA","8","Select","Select",""],["","50383070016","FLUTICASONE","50MCG","16","Select","Select",""],["","50383070016","FLUTICASONE ","SPR 50MCG","16","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","",""],["Yes","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":""}]}]}