{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" WILLIAM WILKEY","gend":0,"add":"1465 WHITTAMORE ROAD","city":"CHESAPEAKE","state":"VA","zip":"23322-9998","dob":"1971-10-11","age":"","mstatus":"","insh":"4290844*02","cliId":"","pno":"757\/373-3850","cno":"757\/373-3850, 757\/373-3850, ","email":"","ename":"","eno":"","pphy":"BRAND, SAMANTHA M MD","ppno":"757\/410-4488","pcpadd":"1024 BATTLEFIELD BLVD S","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":"23322-9998","pcpcounty":"","pcpid":120527,"pcpname":"Hanbury Family Medicine","plan":"OHP - OPTIMA","program":"ACA","lob":"Individual","region":"TIDEWATER","aligned":"","ano":"","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":["R79.89","Z23.","I10.","E29.1","E78.00","R73.01","R53.83","E55.9","I71.2","N28.89","C64.1","J06.9","F33.1","F41.1","Z08.","Z85.528","N40.0","G47.33","G47.00","T88.8XXA","Q23.1","E66.09","F32.9","Z68.33","J45.20","R05.","J01.00","I35.9","K21.9","Z82.0","R45.4","Z71.6","R91.1"],"date":["2021-05-17","2020-11-16","2021-05-17","2021-05-17","2021-05-17","2021-05-17","2020-11-09","2021-05-17","2021-05-17","2021-05-17","2021-05-17","2020-03-09","2020-09-14","2020-09-14","2020-06-03","2020-06-03","2020-06-03","2021-06-23","2021-06-23","2021-06-23","2020-06-30","2020-06-30","2021-05-17","2020-06-30","2021-05-17","2020-04-01","2020-04-01","2021-01-12","2020-06-23","2020-06-23","2020-06-23","2020-06-23","2021-01-07"],"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":[["","68180029606","DULOXETINE","60MG","60","Select","Select",""],["","68180055409","QUINAPRIL","40MG","-30","Select","Select",""],["","68180072103","AMLODIPINE","10MG","30","Select","Select",""],["","68382024701","BENZONATATE","100MG","-30","Select","Select",""],["","45802008801","ALBUTEROL","HFA","8","Select","Select",""],["","00527293341","PREDNISONE","10MG","21","Select","Select",""],["","64764075030","TRINTELLIX","20MG","30","Select","Select",""],["","69097080232","TESTOST","200MG\/ML","10","Select","Select",""],["","68180047802","SIMVASTATIN","10MG","90","Select","Select",""],["","00143980350","DOXYCYCL","100MG","28","Select","Select",""],["","53191036201","VITAMIN","50000UNT","4","Select","Select",""],["","68382009505","CARVEDILOL","25MG","-180","Select","Select",""],["","08290309574","3ML","22GX1.5\"","4","Select","Select",""],["","00054327099","FLUTICASONE","50MCG","-16","Select","Select",""],["","62332054760","CLOBETASOL","0.05%","-30","Select","Select",""],["","65862064163","AZITHROMYCIN","250MG","6","Select","Select",""],["","50111043303","TRAZODONE","50MG","30","Select","Select",""],["","31722072610","MONTELUKAST","10MG","90","Select","Select",""],["","59310057922","PROAIR","","8","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":""}]}]}