{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MARION   E QUINN","gend":1,"add":"6028 OLD PHILLIPS RD","city":"NORFOLK","state":"VA","zip":"23502-9998","dob":"1965-12-12","age":"","mstatus":"","insh":"4096746*02","cliId":"","pno":"757\/461-1947","cno":"757\/461-1947","email":"","ename":"","eno":"","pphy":"MATAWARAN, RAMON MD","ppno":"757\/975-4695","pcpadd":"1232 PERIMETER PARKWAY STE 206","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23454,"pcpcounty":"","pcpid":213434,"pcpname":"","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"757\/408-8010","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/852-0699","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E11.9","D68.61","F41.1","R60.0","M79.605","M79.604","L65.9","D50.0","L30.9","F32.9","R23.8","E55.9","I83.891","I87.393","D89.89","M25.50","K12.30","D50.9","G24.5","M25.512","L71.9","I78.1","L40.9","M32.9","H69.93","E78.5","R59.0","S20.461A","N95.0","R30.9","R07.9","R06.00","R31.29","R07.89","R31.9","R30.0","Z91.14","M65.841","N39.0","N95.1","D16.4","M88.0","R93.89","M35.9","H25.13","M32.8","Z79.899","K42.9","R91.8","R10.9","Z12.31","R00.2","S20.369A","W57.XXXA","Z01.419","Z13.820","E11.69","Z23.","M76.71","M79.671","B35.3","I87.2","R42.","H93.293","H93.299","R74.8","Z86.010","K21.9","R20.2","E61.1","M54.16","Z12.11","D64.9","I83.812"],"date":["2021-11-22","2021-11-01","2021-04-28","2021-03-25","2021-11-22","2021-03-25","2021-02-26","2021-11-08","2021-11-22","2021-03-17","2021-03-15","2021-11-12","2021-03-25","2021-03-25","2021-09-07","2021-09-07","2021-09-07","2021-11-16","2021-01-15","2021-01-15","2021-01-15","2021-01-15","2021-10-11","2021-11-22","2021-06-01","2021-10-28","2021-06-01","2021-06-26","2021-07-19","2021-11-17","2021-10-11","2021-08-03","2021-08-20","2021-08-09","2021-08-09","2021-09-07","2021-09-07","2021-08-16","2021-11-22","2021-09-17","2021-09-28","2021-10-05","2021-11-01","2021-09-23","2021-09-14","2021-09-14","2021-09-14","2021-08-20","2021-08-20","2021-08-20","2021-11-17","2021-10-19","2021-10-20","2021-10-20","2021-11-12","2021-11-12","2021-10-28","2021-11-01","2021-11-01","2021-11-01","2021-11-01","2021-11-22","2021-10-11","2021-10-07","2021-10-07","2021-11-16","2021-11-16","2021-11-16","2021-11-22","2021-11-22","2021-11-22","2021-08-30","2021-11-01","2021-11-15"],"priorHcc":[null,null,"","",null,"","",null,null,"","",null,"","","","","",null,"","","","",null,null,"",null,"","","",null,null,"","","","","","","",null,"",null,null,null,"","","","","","","",null,null,null,null,null,null,null,null,null,null,null,null,null,null,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":[["","68180095604","CLOBETASOL","0.05%","60","Select","Select",""],["","53885024510","ONETOUCH","ULTRA","300","Select","Select",""],["","66993087861","CALCIPOTRIEN","0.01%","60","Select","Select",""],["","00172392570","DIAZEPAM","2MG","12","Select","Select",""],["","16729042210","TACROLIMUS","0.10%","30","Select","Select",""],["","00006008131","JANUMET","100-1000","-90","Select","Select",""],["","59212056210","PLAQUENIL","200MG","180","Select","Select",""],["","49502050002","EPIPEN","0.3MG","2","Select","Select",""],["","68382075810","METFORMIN","500MG","-180","Select","Select",""],["","00378001401","METHOTREXATE","2.5MG","24","Select","Select",""],["","00186504031","NEXIUM","40MG","-180","Select","Select",""],["","00228202750","ALPRAZOLAM","0.25MG","-30","Select","Select",""],["","00071015523","LIPITOR","10MG","90","Select","Select",""],["","69315012710","FOLIC","1000MCG","-90","Select","Select",""],["","00193731221","CONTOUR","NEXT","300","Select","Select",""],["","66993087861","CALCIPOTRIEN ","0.01%","-60","Select","Select",""],["","53885024510","ONETOUCH ","ULTRA","300","Select","Select",""],["","68180095604","CLOBETASOL ","0.05%","60","Select","Select",""],["","00172392570","DIAZEPAM ","2MG","-12","Select","Select",""],["","00006008131","JANUMET ","100-1000","-90","Select","Select",""],["","59212056210","PLAQUENIL ","200MG","180","Select","Select",""],["","00186504031","NEXIUM ","40MG","180","Select","Select",""],["","65862000899","METFORMIN ","500MG","180","Select","Select",""],["","16729042210","TACROLIMUS ","0.10%","-30","Select","Select",""],["","00193731221","CONTOUR ","NEXT","300","Select","Select",""],["","00228202750","ALPRAZOLAM ","0.25MG","30","Select","Select",""],["","00071015523","LIPITOR ","10MG","90","Select","Select",""],["","00378001401","METHOTREXATE ","2.5MG","24","Select","Select",""],["","69315012710","FOLIC ","1000MCG","-90","Select","Select",""],["","49502050002","EPIPEN ","0.3MG","-2","Select","Select",""],["","52427028501","MACROBID ","100MG","6","Select","Select",""],["","52427028501","MACROBID","100MG","6","Select","Select",""],["","00378877035","ESTRADIOL","0.01%","42","Select","Select",""],["","31722057330","ESOMEPRA","40MG DR","-180","Select","Select",""],["","51672404806","CLOTRIM\/BETA","DIPROP","-45","Select","Select",""],["","51672404806","CLOTRIM\/BETA ","CRE DIPROP","45","Select","Select",""],["","31722057330","ESOMEPRA ","CAP 40MG DR","-180","Select","Select",""],["","00378877035","ESTRADIOL ","CRE 0.0001","42","Select","Select",""],["","00093598627","EPINEPHRINE ","INJ 0.3MG","-2","Select","Select",""],["","70377002711","ATORVASTATIN ","TAB 10MG","90","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":""}]}]}