{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JENNIFER CRAIN","gend":1,"add":"111 TAZEWELL ST STE 200","city":"NORFOLK","state":"VA","zip":"23510-9998","dob":"1964-08-11","age":"","mstatus":"","insh":"4591305*01","cliId":"","pno":"757\/410-9319","cno":"757\/410-9319","email":"","ename":"","eno":"","pphy":"JONES, GLENN C MD","ppno":"757\/252-9300","pcpadd":"STE 900 301 RIVERVIEW AVE","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23510,"pcpcounty":"","pcpid":161498,"pcpname":"SMG - Dedicated Care Center","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"757\/631-6710","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/510-9278","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M54.40","M54.6","W19.XXXA","E78.5","K21.9","M34.9","R94.2","I25.10","R07.9","F34.1","G47.33","Z99.89","M79.641","R22.31","M79.642","M77.41","M20.5X1","M79.671","Z98.890","M34.1","M21.6X1","Z72.0","M21.6X2","R53.83","N95.1","R05.","J20.9","J98.01","R03.0","Z87.891","D48.5","L57.0","L82.1","D22.9","Z85.828","M51.26","M47.26","M48.061","M48.07","M54.16","R76.8","D72.829","I10.","F17.210","Z88.8","Z88.5","Z88.1","Z88.2","Z95.5","Z82.49","R06.02","F33.2","Z00.00","K57.90","Z12.4","M87.059","S76.301A","I70.0","M79.604","I25.118","R07.89","R52.","F41.9","F32.9","Z79.82","Z79.1","Z79.899","H91.93","R41.3","F33.1","K22.4","Z12.31","J02.9","Z71.89","R50.9","K58.0","K86.81","L98.9","M25.562","Z01.419","F17.219","M99.73","Z80.3","Z03.818","R11.0","D16.01","K57.32","K59.1","R10.30","M70.61","M87.052","M87.051","M25.551","M25.552","M25.561","M79.675","H00.011","R22.0","Z98.51","R14.3","F33.42","G44.229","I25.2","G47.00","Z60.8","I95.9","J98.4","R91.8","R41.89","Z12.11","Z12.39","Z56.6","L82.0","L57.8","L68.9","Z71.9","R10.2","M54.50","R25.2"],"date":["2021-01-13","2020-12-22","2020-12-22","2021-07-29","2021-07-29","2021-09-03","2021-06-21","2021-07-27","2021-06-08","2021-11-18","2021-07-29","2021-07-29","2020-06-26","2020-06-26","2020-06-26","2021-03-25","2021-03-25","2021-03-25","2021-03-25","2021-07-29","2021-03-25","2021-11-01","2021-03-25","2021-04-29","2021-04-29","2021-09-02","2020-04-20","2020-04-10","2021-07-27","2020-04-20","2020-06-25","2021-10-07","2021-09-03","2020-11-20","2021-07-27","2021-01-05","2021-01-05","2021-11-23","2021-01-05","2021-01-05","2021-04-14","2021-06-08","2021-07-27","2021-07-27","2021-07-27","2021-07-27","2021-07-27","2021-07-27","2021-07-27","2021-07-27","2021-07-27","2021-09-20","2021-07-29","2020-05-21","2020-07-22","2020-09-23","2020-09-23","2021-03-18","2020-09-24","2021-07-29","2021-06-08","2020-08-17","2021-07-29","2020-12-14","2020-12-14","2020-12-14","2020-12-14","2021-07-29","2021-04-29","2021-06-02","2021-04-30","2020-02-26","2020-03-12","2020-05-21","2020-09-04","2020-09-16","2020-05-21","2020-05-21","2020-10-21","2021-11-01","2021-11-01","2021-01-05","2020-02-26","2020-04-10","2020-07-01","2020-08-17","2020-09-16","2020-09-16","2020-09-16","2020-10-21","2021-03-18","2020-10-21","2020-10-21","2020-10-21","2020-10-21","2021-03-18","2020-04-04","2020-07-02","2020-09-04","2020-09-04","2020-11-20","2020-11-20","2020-11-20","2020-11-20","2020-11-20","2021-04-27","2021-04-27","2021-06-21","2021-06-02","2021-07-29","2021-07-29","2021-07-27","2021-09-03","2021-09-03","2021-09-03","2021-09-03","2021-11-01","2021-11-23","2021-11-23"],"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":[["","51660020005","EZETIMIBE","10MG","90","Select","Select",""],["","00228202750","ALPRAZOLAM","0.25MG","60","Select","Select",""],["","70377000812","ROSUVASTATIN","20MG","30","Select","Select",""],["","64764075030","TRINTELLIX","20MG","30","Select","Select",""],["","64764017530","DEXILANT","60MG DR","90","Select","Select",""],["","16714047801","AMOX\/K","875-125","20","Select","Select",""],["","68382080705","TRAZODONE","150MG","60","Select","Select",""],["","16714069211","FLUCONAZOLE","150MG","2","Select","Select",""],["","76385010001","METHSCOPOLAM","2.5MG","-60","Select","Select",""],["","65862006299","METOPROL","25MG","30","Select","Select",""],["","00904625549","SORE","15-3.6MG","20","Select","Select",""],["","31722070090","LOSARTAN","25MG","90","Select","Select",""],["","65162083366","DICLOFENAC","1%","100","Select","Select",""],["","68462063945","NITROGLYCERN","0.4MG","-25","Select","Select",""],["","72647033104","METHYLPRED","4MG","21","Select","Select",""],["","62542030117","HYD","10-8\/5ML","120","Select","Select",""],["","00173071720","ADVAIR","230\/21","12","Select","Select",""],["","00054001729","PREDNISONE","10MG","21","Select","Select",""],["","62175061743","PANTOPRAZOLE","40MG","-90","Select","Select",""],["","66993001968","ALBUTEROL","HFA","54","Select","Select",""],["","42192034001","HYOSCYAMINE","0.125MG","120","Select","Select",""],["","59310057922","PROAIR","","26","Select","Select",""],["","61442022301","CIPROFLOXACN","500MG","10","Select","Select",""],["","75987004005","PENNSAID","2%","112","Select","Select",""],["","64679096105","AZITHROMYCIN","250MG","6","Select","Select",""],["","68462041820","LIDOCAINE","5%","-35","Select","Select",""],["","60432060416","PROMETHAZINE","DM","118","Select","Select",""],["","69543025216","VIRTUSSIN","100-10\/5","60","Select","Select",""],["","31722094101","HYDROCO\/APAP","5-325MG","18","Select","Select",""],["","00591079501","DICYCLOMINE","20MG","30","Select","Select",""],["","00009045003","COLESTID","1GM","60","Select","Select",""],["","65862039010","ONDANSETRON","4MG ODT","12","Select","Select",""],["","00054327099","FLUTICASONE","50MCG","48","Select","Select",""],["","69097081307","GABAPENTIN","100MG","90","Select","Select",""],["","65862019105","CYCLOBENZAPR","10MG","30","Select","Select",""],["","00228202750","ALPRAZOLAM ","0.25MG","60","Select","Select",""],["","51660020005","EZETIMIBE ","10MG","90","Select","Select",""],["","70377000812","ROSUVASTATIN ","20MG","30","Select","Select",""],["","16714069211","FLUCONAZOLE ","150MG","2","Select","Select",""],["","00904625549","SORE ","15-3.6MG","20","Select","Select",""],["","64764017530","DEXILANT ","60MG DR","90","Select","Select",""],["","16714047801","AMOX\/K ","875-125","20","Select","Select",""],["","68382080705","TRAZODONE ","150MG","60","Select","Select",""],["","42192034001","HYOSCYAMINE ","0.125MG","120","Select","Select",""],["","64679096105","AZITHROMYCIN ","250MG","6","Select","Select",""],["","62542030117","HYD ","10-8\/5ML","120","Select","Select",""],["","64764075030","TRINTELLIX ","20MG","30","Select","Select",""],["","69543025216","VIRTUSSIN ","100-10\/5","60","Select","Select",""],["","00173071720","ADVAIR ","230\/21","12","Select","Select",""],["","00054001729","PREDNISONE ","10MG","21","Select","Select",""],["","60432060416","PROMETHAZINE ","DM","118","Select","Select",""],["","16714097601","DICLOFENAC ","1%","100","Select","Select",""],["","65862006299","METOPROL ","25MG","30","Select","Select",""],["","00591079501","DICYCLOMINE ","20MG","30","Select","Select",""],["","31722094101","HYDROCO\/APAP ","5-325MG","18","Select","Select",""],["","76385010001","METHSCOPOLAM ","2.5MG","-60","Select","Select",""],["","65862039010","ONDANSETRON ","4MG ODT","12","Select","Select",""],["","00009045003","COLESTID ","1GM","60","Select","Select",""],["","68462063945","NITROGLYCERN ","0.4MG","25","Select","Select",""],["","72647033104","METHYLPRED ","4MG","21","Select","Select",""],["","31722070090","LOSARTAN ","25MG","90","Select","Select",""],["","69097081307","GABAPENTIN ","100MG","90","Select","Select",""],["","65862019105","CYCLOBENZAPR ","10MG","30","Select","Select",""],["","62175061743","PANTOPRAZOLE ","40MG","-90","Select","Select",""],["","59310057922","PROAIR ","","26","Select","Select",""],["","66993001968","ALBUTEROL ","HFA","54","Select","Select",""],["","00054327099","FLUTICASONE ","50MCG","48","Select","Select",""],["","61442022301","CIPROFLOXACN ","500MG","10","Select","Select",""],["","68462041820","LIDOCAINE ","5%","35","Select","Select",""],["","75987004005","PENNSAID ","2%","112","Select","Select",""],["","66530024940","FLUOROURACIL","5%","40","Select","Select",""],["","00173068220","VENTOLIN","","18","Select","Select",""],["","00023485745","VANIQA","13.90%","45","Select","Select",""],["","00093354143","ESTRADIOL","0.01%","42","Select","Select",""],["","66530024940","FLUOROURACIL ","CRE 0.05","40","Select","Select",""],["","00093354143","ESTRADIOL ","CRE 0.0001","-42","Select","Select",""],["","00173068220","VENTOLIN ","AER ","18","Select","Select",""],["","00023485745","VANIQA ","CRE 0.139","45","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":""}]}]}