{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CATHERINE   GRACE RIFFLE","gend":1,"add":"219 1\/2 HOLLAND DR","city":"VIRGINIA BEACH","state":"VA","zip":"23462-9998","dob":"1968-04-10","age":"","mstatus":"","insh":"5292913*01","cliId":"","pno":"757\/522-9749","cno":"757\/522-9749","email":"","ename":"","eno":"","pphy":"PALMISANO, DAVID MD","ppno":"757\/410-4488","pcpadd":"1024 S BATTLEFIELD BLVD","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":23320,"pcpcounty":"","pcpid":120527,"pcpname":"Hanbury Family Medicine","plan":"OHP","program":"ACA","lob":"Individual","region":"TIDEWATER","aligned":"","ano":"252\/267-7802","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/410-4450","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F33.0","G47.30","E66.01","G43.909","M79.2","G25.81","M79.18","G44.209","G47.33","Z23.","F43.10","H93.8X3","H90.3","G43.809","H93.13","R42.","J33.9","G43.719","H93.11","M25.552","Z00.00","R73.09","E78.5","I25.10","E55.9","Z12.31","Z12.11","Z71.3","I10.","Z68.41","F43.20","F33.2","F41.1","Z87.820","F48.2","R06.83","Z72.0","I35.1","R51.9","G89.29","E66.9","J44.9","M76.51","M25.561","M76.52","M25.562","Z12.4","F90.0","F33.1","Z01.411","N95.9","R10.9","R87.619","R93.89","R10.31","R10.2","M65.331","M67.843","F41.9","M19.90","K21.9","M79.7","F17.210","Z79.899","Z79.51","Z88.5","Z91.030","D22.5","L82.1","L81.2","L85.8","L91.8","R52."],"date":["2020-12-19","2021-11-15","2021-11-15","2020-10-07","2021-04-05","2020-10-07","2021-04-05","2020-10-07","2021-04-07","2021-05-07","2020-03-19","2020-03-16","2020-03-16","2020-03-16","2020-01-15","2020-03-16","2020-02-18","2021-04-05","2020-03-16","2020-06-19","2020-10-26","2020-10-26","2020-11-20","2020-11-20","2020-10-26","2021-01-08","2021-05-23","2020-12-04","2021-11-15","2021-11-15","2021-10-01","2021-11-06","2021-11-06","2021-09-11","2021-11-20","2020-11-20","2021-09-15","2020-11-20","2021-11-15","2021-08-20","2020-08-31","2021-11-15","2021-08-20","2021-08-20","2021-08-20","2021-08-20","2021-09-20","2021-11-20","2021-10-30","2021-09-15","2021-09-15","2021-09-15","2021-10-28","2021-10-28","2021-10-28","2021-10-28","2021-11-15","2021-11-15","2021-11-15","2021-11-15","2021-11-15","2021-11-15","2021-11-15","2021-11-15","2021-11-15","2021-11-15","2021-11-15","2021-11-18","2021-11-18","2021-11-18","2021-11-18","2021-11-18","2021-10-19"],"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]}},{"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":[["","64597030160","NUEDEXTA ","20-10MG","60","Select","Select",""],["","0","","","-600","Select","Select",""],["","55111018015","TIZANIDINE ","4MG","90","Select","Select",""],["","65862052301","GABAPENTIN ","600MG","270","Select","Select",""],["","68382013814","TOPIRAMATE ","25MG","180","Select","Select",""],["","65862064163","AZITHROMYCIN ","250MG","6","Select","Select",""],["","61442010301","DICLOFENAC ","75MG DR","21","Select","Select",""],["","66689000816","NYSTATIN ","100000","600","Select","Select",""],["","55111029309","SUMATRIPTAN ","100MG","9","Select","Select",""],["","62332003031","ROPINIROLE ","0.25MG","30","Select","Select",""],["","57237010099","METOPROL ","25MG","-180","Select","Select",""],["","59746017509","PREDNISONE ","20MG","12","Select","Select",""],["","64597030160","NUEDEXTA","20-10MG","-60","Select","Select",""],["","68382013814","TOPIRAMATE","25MG","180","Select","Select",""],["","65862052301","GABAPENTIN","600MG","270","Select","Select",""],["","55111018015","TIZANIDINE","4MG","90","Select","Select",""],["","61442010301","DICLOFENAC","75MG DR","21","Select","Select",""],["","65862064163","AZITHROMYCIN","250MG","6","Select","Select",""],["","55111029309","SUMATRIPTAN","100MG","12","Select","Select",""],["","66689000816","NYSTATIN","100000","-200","Select","Select",""],["","62332003031","ROPINIROLE","0.25MG","30","Select","Select",""],["","57237010099","METOPROL","25MG","-180","Select","Select",""],["","59746017509","PREDNISONE","20MG","12","Select","Select",""],["","31722000290","VENLAFAXINE","37.5 ER","30","Select","Select",""],["","31722071730","ATOMOXETINE","40MG","30","Select","Select",""],["","31722071730","ATOMOXETINE ","CAP 40MG","30","Select","Select",""],["","31722000290","VENLAFAXINE ","CAP 37.5 ER","30","Select","Select",""],["","57664037718","TRAMADOL ","TAB 50MG","30","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":""}]}]}