{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ASHLIE HANCOCK","gend":1,"add":"1257 WEST RD","city":"CHESAPEAKE","state":"VA","zip":"23323-9998","dob":"1968-11-16","age":"","mstatus":"","insh":"4612574*01","cliId":"","pno":"757\/572-9043","cno":"757\/572-9043","email":"","ename":"","eno":"","pphy":"JOHNSTON, VINCENT MD","ppno":"757\/549-9935","pcpadd":"HAMP RDS-CONTRACT REP 5000 COX RD S","pcpcity":"GLEN ALLEN","pcpstate":"VA","pcpzip":23060,"pcpcounty":"","pcpid":125389,"pcpname":"","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/968-4243","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M51.36","G89.4","Z79.899","M16.12","T50.905D","M06.89","M17.0","L03.90","N17.9","R19.5","Z00.00","E89.0","Z13.220","E55.9","M17.11","E89.2","T84.033A","M19.90","E20.8","M06.9","K59.09","K21.9","M17.12","Z88.9","J45.909","J30.81","J30.1","J30.89","H10.13","Z80.3","R10.2","Z71.9","Z84.81","G47.30","E03.9","E66.01","Z68.41","Z90.49","Z90.710","Z90.721","Z88.1","Z88.2","Z88.6","Z88.8","J45.30","H01.009","Z11.0","Z13.6","M25.562","Z12.31","Z01.419","L03.316","Z15.01","R92.1","L42.","R05.","D89.9","R00.2","R60.9","I10.","I71.2","J02.9","M06.09","Z71.89","E83.51","E83.39","M25.561","Z12.39","I25.10","R32.","Z96.652","I87.2","R21.","Z12.11","K64.8","Z83.71","Z68.42","Z79.51","G25.81","Z90.89","Z87.19","E66.9","H40.013","S05.11XA","Z91.89","Z01.812","Z20.822","Z01.818","Z86.718","Z79.890","Z90.722","Z90.5","Z91.012","Z91.040","Z91.011","Z40.01","R10.9","R50.9","Z20.828","B34.9"],"date":["2021-10-11","2021-10-11","2021-10-11","2021-10-11","2021-10-11","2021-10-11","2021-10-11","2021-10-11","2021-09-13","2020-05-20","2020-09-18","2021-08-13","2020-05-21","2021-09-13","2021-08-13","2021-09-13","2021-04-19","2021-04-19","2021-04-19","2021-07-02","2021-04-19","2021-04-19","2021-04-19","2021-04-19","2021-07-02","2021-10-18","2021-10-18","2021-10-18","2020-10-23","2021-07-02","2021-02-01","2021-03-10","2021-02-01","2021-02-01","2021-02-01","2021-02-01","2021-02-01","2021-02-01","2021-02-01","2021-02-01","2021-07-02","2021-07-02","2021-07-02","2021-07-02","2021-02-08","2021-02-08","2021-06-03","2021-06-03","2021-03-15","2021-05-20","2020-09-17","2021-02-14","2020-09-25","2020-09-25","2020-01-21","2020-03-26","2020-03-26","2020-03-30","2020-03-30","2021-06-03","2020-03-30","2020-12-06","2021-09-07","2021-09-07","2021-09-13","2020-04-27","2021-09-07","2020-09-25","2020-09-25","2020-09-25","2021-03-15","2021-05-15","2020-03-13","2020-08-11","2020-08-11","2020-08-11","2020-08-11","2020-08-11","2020-08-11","2020-08-11","2020-08-11","2021-03-10","2021-01-11","2021-01-11","2021-07-06","2021-06-29","2021-06-29","2021-06-29","2021-07-02","2021-07-02","2021-07-02","2021-07-02","2021-07-02","2021-07-02","2021-07-02","2021-07-02","2021-09-01","2021-11-05","2021-11-15","2021-11-15"],"priorHcc":[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":[["","65862020901","MINOCYCLINE","50MG","60","Select","Select",""],["","69097052444","DICLOFENAC","1%","200","Select","Select",""],["","31722072690","MONTELUKAST","10MG","90","Select","Select",""],["","55111018015","TIZANIDINE","4MG","90","Select","Select",""],["","00074055402","HUMIRA","40\/0.4ML","2","Select","Select",""],["","00781808926","AZITHROMYCIN","250MG","-6","Select","Select",""],["","68180069806","TRAMADOL","200MG ER","30","Select","Select",""],["","65162070486","FLUOCIN","BODY","-118","Select","Select",""],["","00456120230","LINZESS","290MCG","30","Select","Select",""],["","59137052004","RASUVO","15MG","-1","Select","Select",""],["","69315012701","FOLIC","1000MCG","90","Select","Select",""],["","64727330001","NATURE-THROI","65MG","-120","Select","Select",""],["","60842002301","AUVI-Q","0.3MG","2","Select","Select",""],["","54092060601","XIIDRA","5%","180","Select","Select",""],["","00574402435","ERYTHROMYCIN","5MG\/GM","4","Select","Select",""],["","59746000103","METHYLPRED","4MG","21","Select","Select",""],["","69452020720","CALCITRIOL","0.25MCG","270","Select","Select",""],["","42794001912","LIOTHYRONINE","25MCG","-30","Select","Select",""],["","69238183801","LEVOTHYROXIN","150MCG","90","Select","Select",""],["","00406012305","HYDROCO\/APAP","5-325MG","90","Select","Select",""],["","57237007710","ONDANSETRON","4MG ODT","16","Select","Select",""],["","43547040111","FUROSEMIDE","20MG","90","Select","Select",""],["","00406055201","OXYCODONE","5MG","12","Select","Select",""],["","63481068706","LIDODERM","5%","30","Select","Select",""],["","67877021620","CEFUROXIME","500MG","20","Select","Select",""],["","00406051205","OXYCOD\/APAP","5-325MG","12","Select","Select",""],["","00591352530","LIDOCAINE","5%","60","Select","Select",""],["","00173068220","VENTOLIN","","18","Select","Select",""],["","13811071910","NITROFURANTN","100MG","6","Select","Select",""],["","00065064835","TOBRADEX","0.3-0.1%","4","Select","Select",""],["","66993001968","ALBUTEROL","HFA","18","Select","Select",""],["","55111018015","TIZANIDINE ","4MG","90","Select","Select",""],["","65862020901","MINOCYCLINE ","50MG","60","Select","Select",""],["","31722072690","MONTELUKAST ","10MG","-30","Select","Select",""],["","00781808926","AZITHROMYCIN ","250MG","6","Select","Select",""],["","69097052444","DICLOFENAC ","1%","200","Select","Select",""],["","68180069806","TRAMADOL ","200MG ER","30","Select","Select",""],["","00574402435","ERYTHROMYCIN ","5MG\/GM","4","Select","Select",""],["","69452020720","CALCITRIOL ","0.25MCG","270","Select","Select",""],["","65162070486","FLUOCIN ","BODY","-118","Select","Select",""],["","00456120230","LINZESS ","290MCG","30","Select","Select",""],["","59137052004","RASUVO ","15MG","-1","Select","Select",""],["","00074055402","HUMIRA ","40\/0.4ML","2","Select","Select",""],["","54092060601","XIIDRA ","5%","180","Select","Select",""],["","59746000103","METHYLPRED ","4MG","21","Select","Select",""],["","64727330001","NATURE-THROI ","65MG","120","Select","Select",""],["","69315012701","FOLIC ","1000MCG","90","Select","Select",""],["","60842002301","AUVI-Q ","0.3MG","2","Select","Select",""],["","42794001912","LIOTHYRONINE ","25MCG","-30","Select","Select",""],["","69238183801","LEVOTHYROXIN ","150MCG","-90","Select","Select",""],["","13811071910","NITROFURANTN ","100MG","6","Select","Select",""],["","00406012305","HYDROCO\/APAP ","5-325MG","90","Select","Select",""],["","68462015713","ONDANSETRON ","4MG ODT","-16","Select","Select",""],["","66993001968","ALBUTEROL ","HFA","18","Select","Select",""],["","00406051205","OXYCOD\/APAP ","5-325MG","12","Select","Select",""],["","00173068220","VENTOLIN ","","-18","Select","Select",""],["","67877021620","CEFUROXIME ","500MG","20","Select","Select",""],["","00054429731","FUROSEMIDE ","20MG","90","Select","Select",""],["","63481068706","LIDODERM ","5%","30","Select","Select",""],["","00591352530","LIDOCAINE ","5%","2","Select","Select",""],["","00406055201","OXYCODONE ","5MG","12","Select","Select",""],["","00065064835","TOBRADEX ","0.3-0.1%","4","Select","Select",""],["","16729018201","HYDROCHLOROT","12.5MG","90","Select","Select",""],["","59267100002","PFIZER","COVID-19","0","Select","Select",""],["","59267100002","PFIZER ","INJ COVID-19","0","Select","Select",""],["","67877057305","BENZONATATE ","CAP 100MG","15","Select","Select",""],["","16729018201","HYDROCHLOROT ","TAB 12.5MG","90","Select","Select",""],["","00121077504","GG\/CODEINE ","SOL 100-10\/5","118","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":""}]}]}