{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"AMY HOGGARD","gend":1,"add":"300 SABAL PALM LN APT 107","city":"CHESAPEAKE","state":"VA","zip":"23320-9998","dob":"1969-12-07","age":"","mstatus":"","insh":"5354919*01","cliId":"","pno":"757\/438-7280","cno":"757\/438-7280","email":"","ename":"","eno":"","pphy":"AKRAGORN, EKKARAT MD","ppno":"757\/410-2287","pcpadd":"112 GAINSBOROUGH SQUARE #100","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":23320,"pcpcounty":"","pcpid":164325,"pcpname":"","plan":"OHP","program":"ACA","lob":"Individual","region":"TIDEWATER","aligned":"","ano":"757\/438-7280","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/410-4474","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["L03.319","L03.116","M54.2","S00.93XA","V89.2XXA","M25.512","I10.","R11.10","R10.10","M25.561","M25.562","M17.11","M17.12","M17.0","R11.2","J02.9","R09.89","Z11.59","R05.","N20.0","K42.9","R19.7","R10.11","Z20.828","F32.9","R21.","Z90.49","Z87.891","Z79.899","Z88.5","R00.2","R07.89","W19.XXXA","Z12.11","Z68.44","H10.9","J20.9","R23.8","R22.43"],"date":["2020-07-01","2020-07-01","2020-07-03","2020-07-03","2020-07-01","2020-07-03","2021-03-05","2020-05-17","2020-05-17","2021-10-01","2021-10-01","2020-11-06","2020-11-06","2021-10-01","2020-07-03","2020-03-11","2020-03-11","2020-03-11","2020-05-17","2020-05-17","2020-05-17","2020-05-17","2020-05-17","2020-06-16","2020-05-17","2020-05-17","2020-05-17","2020-05-17","2020-05-17","2020-05-17","2020-05-17","2020-12-22","2020-12-22","2021-05-23","2020-11-06","2020-05-21","2020-05-21","2020-05-21","2021-07-30"],"priorHcc":["","","","","","","","","",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":[["","00591024110","LORAZEPAM","1MG","30","Select","Select",""],["","65862037401","ESCITALOPRAM","10MG","30","Select","Select",""],["","13668011690","LOSARTAN\/HCT","50-12.5","30","Select","Select",""],["","68382080601","TRAZODONE","100MG","30","Select","Select",""],["","10370010203","BUPROPN","300MG XL","30","Select","Select",""],["","68382004101","PROMETHAZINE","25MG","15","Select","Select",""],["","16729018201","HYDROCHLOROT","12.5MG","30","Select","Select",""],["","50111078710","AZITHROMYCIN","250MG","6","Select","Select",""],["","61314062810","POLYMYXIN","TRIMETHP","10","Select","Select",""],["","68462059089","FLUOCIN","SCALP","118","Select","Select",""],["","50742061601","METOPROL","50MG ER","30","Select","Select",""],["","68462039429","ALYACEN","Jan-35","28","Select","Select",""],["","31722070190","LOSARTAN","50MG","30","Select","Select",""],["","65862019105","CYCLOBENZAPR","10MG","30","Select","Select",""],["","68462010340","FLUCONAZOLE","150MG","2","Select","Select",""],["","31722077701","ACYCLOVIR","400MG","10","Select","Select",""],["","69543025116","VIRTUSSIN","100-10\/5","120","Select","Select",""],["","00093101042","MUPIROCIN","2%","22","Select","Select",""],["","42806031250","DOXYCYCL","100MG","20","Select","Select",""],["","00093310953","AMOXICILLIN","500MG","21","Select","Select",""],["","65162027210","SMZ\/TMP","800-160","28","Select","Select",""],["","68382080601","TRAZODONE ","100MG","30","Select","Select",""],["","00591024110","LORAZEPAM ","1MG","30","Select","Select",""],["","10370010203","BUPROPN ","300MG XL","30","Select","Select",""],["","13668011690","LOSARTAN\/HCT ","50-12.5","30","Select","Select",""],["","68382004101","PROMETHAZINE ","25MG","15","Select","Select",""],["","65862037401","ESCITALOPRAM ","10MG","30","Select","Select",""],["","68462039429","ALYACEN ","Jan-35","28","Select","Select",""],["","31722070190","LOSARTAN ","50MG","30","Select","Select",""],["","16729018201","HYDROCHLOROT ","12.5MG","30","Select","Select",""],["","61314062810","POLYMYXIN ","TRIMETHP","10","Select","Select",""],["","42806031250","DOXYCYCL ","100MG","20","Select","Select",""],["","68462010340","FLUCONAZOLE ","150MG","2","Select","Select",""],["","69543025116","VIRTUSSIN ","100-10\/5","-120","Select","Select",""],["","65162070486","FLUOCIN ","BODY","118","Select","Select",""],["","65862064163","AZITHROMYCIN ","250MG","6","Select","Select",""],["","65162027210","SMZ\/TMP ","800-160","28","Select","Select",""],["","50742061601","METOPROL ","50MG ER","30","Select","Select",""],["","65862019105","CYCLOBENZAPR ","10MG","30","Select","Select",""],["","31722077701","ACYCLOVIR ","400MG","10","Select","Select",""],["","00093310953","AMOXICILLIN ","500MG","21","Select","Select",""],["","00093101042","MUPIROCIN ","2%","22","Select","Select",""],["","80777027398","MODERNA","COVID-19","0","Select","Select",""],["","80777027398","MODERNA ","INJ COVID-19","0","Select","Select",""],["","00555901058","NORTREL ","TAB 12785","84","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":""}]}]}