{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CARMEN MEYERS","gend":1,"add":"4102 NATURE WAY","city":"NEWPORT NEWS","state":"VA","zip":"23602-9998","dob":"1964-09-17","age":"","mstatus":"","insh":"3064484*02","cliId":"","pno":"757\/768-7292","cno":"757\/768-7292","email":"","ename":"","eno":"","pphy":"MOORE, CHARLOTTE DO","ppno":"757\/369-5784","pcpadd":"SUITE K 1405 KILN CREEK PKWY","pcpcity":"NEWPORT NEWS","pcpstate":"VA","pcpzip":23602,"pcpcounty":"","pcpid":157546,"pcpname":"KILN CREEK FAMILY MEDICINE","plan":"OHP","program":"ACA","lob":"Individual","region":"TIDEWATER","aligned":"","ano":"757\/768-7292","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/369-5785","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["H15.89","R05.","E11.65","I10.","E78.2","E89.0","Z86.010","Z80.0","E66.01","R03.0","M75.52","M50.31","N13.2","R10.32","Z20.828","D72.829","N20.2","G47.33","D53.9","Z68.42","Z79.890","Z79.899","N20.0","H15.013","H40.043","E55.9","R68.89","N13.30","N11.1","N13.4","D64.9","H10.45","H04.123","H15.003","G89.29","J98.11","N23.","M43.16","M47.896","Z12.31","Z01.419","N39.0","Z20.822","E03.9","Z12.11","R78.81","K59.00","N32.89","N81.10","N30.90","B96.20","Z87.442","R10.9","M25.512","K57.30","M51.37","Z23."],"date":["2020-02-13","2020-02-13","2021-10-26","2021-03-18","2021-10-26","2021-10-26","2020-10-19","2020-10-19","2021-03-31","2020-10-19","2020-12-30","2020-12-30","2021-03-18","2021-03-16","2021-03-16","2021-03-16","2021-03-31","2021-03-31","2021-03-31","2021-03-31","2021-03-31","2021-03-31","2021-03-31","2020-04-27","2020-04-27","2021-10-26","2021-02-09","2021-03-20","2021-03-20","2021-03-20","2021-03-19","2020-04-27","2020-04-27","2020-08-26","2020-12-22","2021-03-17","2021-03-17","2020-05-07","2020-05-07","2020-09-08","2020-10-07","2021-03-20","2021-03-16","2021-03-31","2021-05-23","2021-03-18","2021-03-18","2021-03-18","2021-03-18","2021-03-18","2021-03-18","2021-03-18","2021-03-18","2020-12-09","2021-03-16","2021-03-16","2021-10-26"],"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":[["","69452014320","BENZONATATE","100MG","-21","Select","Select",""],["","00023921105","COMBIGAN","0.2\/0.5%","15","Select","Select",""],["","00781518892","LEVOTHYROXIN","175MCG","30","Select","Select",""],["","60432060416","PROMETHAZINE","DM","35","Select","Select",""],["","50111078751","AZITHROMYCIN","250MG","6","Select","Select",""],["","59746017509","PREDNISONE","20MG","60","Select","Select",""],["","60758011905","PREDNISOLONE","1% OP","5","Select","Select",""],["","72305017530","EUTHYROX","175MCG","30","Select","Select",""],["","70010075401","METHOCARBAM","500MG","60","Select","Select",""],["","59746000103","METHYLPRED","4MG","21","Select","Select",""],["","13107005999","APAP\/CODEINE","300-30MG","15","Select","Select",""],["","64380073706","VITAMIN","50000UNT","12","Select","Select",""],["","65162083366","DICLOFENAC","1%","100","Select","Select",""],["","59676058015","JANSSEN","COVID-19","0","Select","Select",""],["","00781518892","LEVOTHYROXIN ","175MCG","30","Select","Select",""],["","60758011905","PREDNISOLONE ","1% OP","5","Select","Select",""],["","69452014320","BENZONATATE ","100MG","21","Select","Select",""],["","50111078751","AZITHROMYCIN ","250MG","6","Select","Select",""],["","60432060416","PROMETHAZINE ","DM","35","Select","Select",""],["","00023921105","COMBIGAN ","0.2\/0.5%","15","Select","Select",""],["","59746017509","PREDNISONE ","20MG","60","Select","Select",""],["","64380073706","VITAMIN ","50000UNT","12","Select","Select",""],["","59746000103","METHYLPRED ","4MG","21","Select","Select",""],["","70010075401","METHOCARBAM ","500MG","-60","Select","Select",""],["","72305017530","EUTHYROX ","175MCG","30","Select","Select",""],["","65162083366","DICLOFENAC ","1%","100","Select","Select",""],["","13107005999","APAP\/CODEINE ","300-30MG","15","Select","Select",""],["","59676058015","JANSSEN ","COVID-19","0","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","",""],["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":""}]}]}