{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JEFFREY   S ANDREWS","gend":0,"add":"153 COMMODORE PL","city":"NORFOLK","state":"VA","zip":"23503-9998","dob":"1970-10-12","age":"","mstatus":"","insh":"4125843*21","cliId":"","pno":"757\/404-8254","cno":"757\/404-8254","email":"","ename":"","eno":"","pphy":"HARRINGTON, THOMAS A MD","ppno":"757\/484-0500","pcpadd":"2994 CHURCHLAND BLVD","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":23321,"pcpcounty":"","pcpid":101382,"pcpname":"","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"757\/352-8044","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K42.9","I10.","E29.1","R31.29","Z12.5","Z00.00","Z23.","R74.8","R53.83","N20.0","Z98.890","N52.9","G95.9","T81.40XA","L03.311","L76.34","M54.2","R10.84","Z83.3","Z82.49","R10.9","E87.0","G56.03","M54.12","G56.22","M54.16","B95.4","K76.0","Z68.37","Z80.9","Z01.810","Z11.59","Z01.818","T81.40XD","Z48.00","Z87.19","Z79.2","N28.1","K57.90","N23.","M48.02","E66.9","Z68.41","N20.1","T14.90XA","S52.032B","S42.462B","K63.5","Z87.442","D12.6","S42.302A","R18.8","K76.89","S36.112A","S59.902A","R57.8","D69.6","J96.91","T14.8XXA","K59.89","S29.9XXA","S42.402A","S42.202A","Z45.2","Z99.81","S31.109A","R91.8","D72.829","S42.409A","T79.4XXA","D64.9","S42.402B","S52.022B","T07.XXXA","X95.9XXD","R53.1","R26.9","R40.4","T50.905A","Z46.59","L08.9","S42.462A","S52.032A","S52.023A","Z87.81","R13.10","R61.","X95.9XXA","K56.7","R50.9","L02.415","R14.0","S52.252A","R68.89","S42.462D","M24.522","S52.032E","S36.530A","S36.438A","S36.893A","S31.601A","S31.609A","L02.211","K65.1","K91.89","R93.422","R93.5","Z98.0","Z90.49","Z12.11","M25.522","R52.","S31.131A","J96.01","S27.321A","S52.035B","K65.9","S35.299A","E87.4","T81.30XA","T81.41XA","S36.899A"],"date":["2021-06-14","2020-08-04","2021-08-09","2021-01-15","2021-07-26","2021-01-12","2020-01-07","2021-06-22","2020-03-23","2021-10-18","2021-10-04","2021-08-09","2020-01-22","2020-07-06","2020-08-04","2020-07-06","2020-12-14","2021-06-22","2021-06-10","2021-06-10","2021-09-03","2021-08-26","2020-12-10","2020-12-10","2020-12-14","2020-12-10","2020-07-05","2021-06-22","2021-06-22","2021-08-03","2020-05-12","2020-05-12","2020-05-12","2020-08-04","2020-08-04","2020-08-04","2020-08-04","2021-10-18","2021-05-19","2021-06-09","2020-01-31","2020-05-15","2021-08-20","2021-06-21","2021-08-20","2021-08-21","2021-08-21","2021-08-03","2021-08-09","2021-08-03","2021-09-20","2021-09-21","2021-10-18","2021-09-10","2021-08-21","2021-08-22","2021-08-22","2021-08-22","2021-09-23","2021-08-29","2021-08-29","2021-09-09","2021-08-20","2021-08-20","2021-08-24","2021-09-20","2021-08-31","2021-09-15","2021-09-27","2021-08-21","2021-08-21","2021-08-22","2021-08-22","2021-09-03","2021-09-03","2021-09-03","2021-09-03","2021-08-20","2021-08-20","2021-08-23","2021-09-23","2021-08-22","2021-08-22","2021-09-27","2021-09-12","2021-08-20","2021-08-20","2021-08-20","2021-09-02","2021-08-27","2021-08-31","2021-09-01","2021-09-05","2021-09-08","2021-11-08","2021-11-15","2021-11-08","2021-08-20","2021-08-20","2021-08-20","2021-08-20","2021-08-21","2021-10-18","2021-10-18","2021-10-18","2021-10-18","2021-10-18","2021-10-18","2021-10-18","2021-08-30","2021-10-08","2021-10-14","2021-08-20","2021-08-20","2021-08-20","2021-08-20","2021-08-20","2021-08-20","2021-08-20","2021-08-20","2021-08-20","2021-08-20"],"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,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":[["","00093314705","CEPHALEXIN","500MG","28","Select","Select",""],["","66685100100","AMOX\/K","875-125","-14","Select","Select",""],["","08290305195","BD HYPO NEED","18GX1\"","4","Select","Select",""],["","08290309628","SYRINGE","-LOK 1ML","-4","Select","Select",""],["","08290305122","BD NEEDLES","25GX5\/8\"","4","Select","Select",""],["","62756001540","TESTOST","200MG\/ML","2","Select","Select",""],["","68382013201","TAMSULOSIN","0.4MG","-4","Select","Select",""],["","00406012305","HYDROCO\/APAP","5-325MG","20","Select","Select",""],["","68462015713","ONDANSETRON","4MG ODT","3","Select","Select",""],["","64380080707","IBUPROFEN","800MG","-30","Select","Select",""],["","00591333001","CYCLOBENZAPR","7.5MG","30","Select","Select",""],["","00406051205","OXYCOD\/APAP","5-325MG","20","Select","Select",""],["","00406051205","OXYCOD\/APAP ","5-325MG","-20","Select","Select",""],["","00093314705","CEPHALEXIN ","500MG","28","Select","Select",""],["","66685100100","AMOX\/K ","875-125","-14","Select","Select",""],["","00406012305","HYDROCO\/APAP ","5-325MG","20","Select","Select",""],["","08290309628","SYRINGE ","-LOK 1ML","4","Select","Select",""],["","62756001540","TESTOST ","200MG\/ML","2","Select","Select",""],["","08290305195","BD  HYPO NEED","18GX1\"","-4","Select","Select",""],["","08290305122","BD  NEEDLES  ","25GX5\/8\"","4","Select","Select",""],["","00591333001","CYCLOBENZAPR ","7.5MG","30","Select","Select",""],["","57237007710","ONDANSETRON ","4MG ODT","3","Select","Select",""],["","64380080707","IBUPROFEN ","800MG","30","Select","Select",""],["","68382013201","TAMSULOSIN ","0.4MG","-4","Select","Select",""],["","00904698160","BISACODYL","10MG","14","Select","Select",""],["","65162062711","TRAMADOL","50MG","25","Select","Select",""],["","00832105415","BACLOFEN","10MG","7","Select","Select",""],["","69547035302","NARCAN","","2","Select","Select",""],["","00527133001","BACLOFEN ","TAB 10MG","30","Select","Select",""],["","00904698160","BISACODYL ","SUP 10MG","14","Select","Select",""],["","65162062711","TRAMADOL ","TAB 50MG","25","Select","Select",""],["","69547035302","NARCAN ","SPR ","2","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":""}]}]}