{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KENNETH   A BURKETT JR","gend":0,"add":"35 GREENBRIER RD","city":"PORTSMOUTH","state":"VA","zip":"23707-9998","dob":"1961-07-05","age":"","mstatus":"","insh":"4840291*01","cliId":"","pno":"757\/405-8023","cno":"757\/405-8023","email":"","ename":"","eno":"","pphy":"BRAWLEY, STEPHEN C MD","ppno":"757\/397-6344","pcpadd":"3640 HIGH STREET SUITE 3B","pcpcity":"PORTSMOUTH","pcpstate":"VA","pcpzip":23707,"pcpcounty":"","pcpid":100340,"pcpname":"","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/606-1185","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M25.561","M17.11","E66.01","Z68.37","E11.65","Z01.818","M17.10","Z13.9","E11.9","Z47.1","Z96.651","R19.5","N40.0","Z12.11","Z20.828","M21.161","Z48.01","M19.90","J45.909","E11.22","I12.9","N18.9","K21.9","G47.33","E66.9","Z68.32","Z87.442","Z79.82","Z79.84","Z79.899","I10.","R68.89","M25.461","E66.3","K59.00","Z86.010","K57.30","K63.5","D12.6","M25.761","Z79.1","Z79.51","Z82.49","Z82.61","Z83.3","G89.18","M51.36","M43.16","M54.5","Z00.00","E83.52","M54.9","M48.061","Z23."],"date":["2021-06-02","2021-04-12","2020-10-22","2020-10-22","2021-09-16","2021-04-02","2021-04-01","2021-04-01","2021-04-01","2021-06-03","2021-06-03","2021-01-04","2021-09-16","2021-01-04","2020-12-17","2021-04-12","2021-04-15","2021-09-03","2021-09-03","2021-09-03","2021-09-03","2021-09-03","2021-09-03","2021-09-16","2021-04-15","2021-04-15","2021-04-15","2021-09-03","2021-09-03","2021-09-03","2021-09-16","2020-08-06","2020-02-06","2021-01-04","2021-01-04","2021-02-16","2021-02-16","2021-02-16","2021-02-16","2021-04-12","2021-04-12","2021-09-03","2021-04-12","2021-04-12","2021-04-12","2021-04-12","2021-09-03","2021-09-03","2021-09-03","2021-09-16","2021-09-16","2021-09-03","2021-09-24","2021-09-16"],"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":[["","70710120901","ALLOPURINOL","100MG","60","Select","Select",""],["","68382031910","TRAMADOL","50MG","30","Select","Select",""],["","00002143480","TRULICITY","1.5\/0.5","2","Select","Select",""],["","45802048678","DOCUSATE","100MG","60","Select","Select",""],["","60505014201","GLIPIZIDE","10MG","90","Select","Select",""],["","53746051401","SPIRONOLACT","50MG","30","Select","Select",""],["","68382076010","METFORMIN","1000MG","180","Select","Select",""],["","50742061610","METOPROL","50MG ER","60","Select","Select",""],["","31722070290","LOSARTAN","100MG","90","Select","Select",""],["","00093720298","PRAVASTATIN","40MG","90","Select","Select",""],["","68180072103","AMLODIPINE","10MG","90","Select","Select",""],["","69097094312","GABAPENTIN","300MG","180","Select","Select",""],["","70377000812","ROSUVASTATIN","20MG","30","Select","Select",""],["","00597015230","JARDIANCE","10MG","-90","Select","Select",""],["","68382097001","CHLORTHALID","25MG","90","Select","Select",""],["","42858010401","OXYCOD\/APAP","10-325MG","56","Select","Select",""],["","68180012202","CEPHALEXIN","500MG","20","Select","Select",""],["","50428152314","CVS","325MG","60","Select","Select",""],["","60505384901","CELECOXIB","200MG","60","Select","Select",""],["","80777027399","MODERNA","COVID-19","0","Select","Select",""],["","57237001401","TAMSULOSIN","0.4MG","90","Select","Select",""],["","50428488021","STOOL","100MG","60","Select","Select",""],["","43386035801","HYDROCO\/APAP","10-325MG","42","Select","Select",""],["","70710120901","ALLOPURINOL ","100MG","60","Select","Select",""],["","68382031910","TRAMADOL ","50MG","30","Select","Select",""],["","00002143480","TRULICITY ","1.5\/0.5","2","Select","Select",""],["","53746051401","SPIRONOLACT ","50MG","30","Select","Select",""],["","68382097001","CHLORTHALID ","25MG","90","Select","Select",""],["","68382076010","METFORMIN ","1000MG","180","Select","Select",""],["","50742061610","METOPROL ","50MG ER","60","Select","Select",""],["","60505014201","GLIPIZIDE ","10MG","90","Select","Select",""],["","68180072103","AMLODIPINE ","10MG","90","Select","Select",""],["","31722070290","LOSARTAN ","100MG","90","Select","Select",""],["","00093720298","PRAVASTATIN ","40MG","90","Select","Select",""],["","69097094312","GABAPENTIN ","300MG","180","Select","Select",""],["","45802048678","DOCUSATE ","100MG","60","Select","Select",""],["","57237001401","TAMSULOSIN ","0.4MG","90","Select","Select",""],["","70377000812","ROSUVASTATIN ","20MG","30","Select","Select",""],["","00597015230","JARDIANCE ","10MG","90","Select","Select",""],["","42858010401","OXYCOD\/APAP ","10-325MG","56","Select","Select",""],["","50428488021","STOOL ","100MG","60","Select","Select",""],["","68180012202","CEPHALEXIN ","500MG","8","Select","Select",""],["","50428152314","CVS ","325MG","-60","Select","Select",""],["","60505384901","CELECOXIB ","200MG","60","Select","Select",""],["","80777027399","MODERNA ","COVID-19","0","Select","Select",""],["","43386035801","HYDROCO\/APAP ","10-325MG","42","Select","Select",""],["","00603459321","METHYLPRED","4MG","-21","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":""}]}]}