{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JULIE LOWERY","gend":1,"add":"103 WARE RD","city":"WILLIAMSBURG","state":"VA","zip":"23185-9998","dob":"1963-03-31","age":"","mstatus":"","insh":"5604079*01","cliId":"","pno":"757\/434-2421","cno":"757\/434-2421","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\/424-1900","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":["I10.","M79.674","F41.9","M79.675","M79.644","M79.645","E83.52","Z12.31","M46.1","M54.5","M51.26","M62.81","R76.8","Z79.899","Z78.9","L40.9","M79.642","M79.641","M79.672","M06.09","M11.20","F51.01","M54.6","G89.29","M25.841","F33.1","R52.","M19.042","M65.20","M65.4","E53.8","E55.9","E78.00","Z00.00","J11.1","M47.896","M47.897","M48.061","M51.27","M51.86","D18.09","G96.191","M67.431","N32.81","M25.40","R60.0","R22.31","D89.89","Z01.411","N39.3","M19.049","M18.11","M47.816","Z68.21","G56.21","Z12.11","N95.2"],"date":["2021-06-30","2020-01-10","2020-08-24","2020-01-10","2020-06-25","2020-06-25","2021-01-19","2020-07-28","2021-05-10","2021-06-30","2021-05-10","2021-05-10","2021-01-19","2020-11-13","2020-11-13","2020-11-13","2020-11-13","2020-11-13","2020-11-13","2020-11-13","2020-11-13","2020-06-25","2020-06-25","2021-06-30","2020-08-24","2021-06-30","2020-09-21","2020-10-09","2020-10-09","2020-10-09","2021-06-30","2021-06-30","2021-06-30","2021-01-19","2021-01-19","2021-04-02","2021-04-02","2021-04-02","2021-04-02","2021-04-02","2021-04-02","2021-04-02","2020-06-09","2020-06-09","2020-09-30","2020-09-30","2020-09-30","2020-10-09","2021-11-10","2020-06-03","2020-09-21","2020-09-30","2021-04-02","2021-04-02","2021-06-30","2021-08-30","2021-11-10"],"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":[["","65862060012","RIZATRIPTAN","10MG","4","Select","Select",""],["","50228018005","GABAPENTIN","300MG","90","Select","Select",""],["","29300012810","HYDROCHLOROT","25MG","30","Select","Select",""],["","68180078001","ZOLPIDEM","12.5MG","30","Select","Select",""],["","00115151866","ESTRADIOL","0.01%","42","Select","Select",""],["","00781106101","ALPRAZOLAM","0.25MG","30","Select","Select",""],["","53191036201","VITAMIN","50000UNT","4","Select","Select",""],["","58160082311","SHINGRIX","50\/0.5ML","-1","Select","Select",""],["","57237001830","DULOXETINE","30MG","90","Select","Select",""],["","68462010340","FLUCONAZOLE","150MG","2","Select","Select",""],["","59746021106","CYCLOBENZAPR","5MG","30","Select","Select",""],["","58160088552","FLUARIX","2020-21","0","Select","Select",""],["","11822059042","MUCUS","60-600MG","30","Select","Select",""],["","50111078710","AZITHROMYCIN","250MG","6","Select","Select",""],["","59746017506","PREDNISONE","20MG","12","Select","Select",""],["","00143924920","AMOX\/K","875-125","20","Select","Select",""],["","64380079901","OSELTAMIVIR","75MG","10","Select","Select",""],["","50228018005","GABAPENTIN ","300MG","90","Select","Select",""],["","65862060012","RIZATRIPTAN ","10MG","4","Select","Select",""],["","68180078001","ZOLPIDEM ","12.5MG","30","Select","Select",""],["","29300012810","HYDROCHLOROT ","25MG","30","Select","Select",""],["","00781106101","ALPRAZOLAM ","0.25MG","30","Select","Select",""],["","57237001830","DULOXETINE ","30MG","90","Select","Select",""],["","53191036201","VITAMIN ","50000UNT","4","Select","Select",""],["","68462010340","FLUCONAZOLE ","150MG","2","Select","Select",""],["","50111078710","AZITHROMYCIN ","250MG","6","Select","Select",""],["","00115151866","ESTRADIOL ","0.01%","42","Select","Select",""],["","58160088552","FLUARIX ","2020-21","0","Select","Select",""],["","58160082311","SHINGRIX ","50\/0.5ML","-1","Select","Select",""],["","64380079901","OSELTAMIVIR ","75MG","10","Select","Select",""],["","00143924920","AMOX\/K ","875-125","20","Select","Select",""],["","59746021106","CYCLOBENZAPR ","5MG","30","Select","Select",""],["","59746017506","PREDNISONE ","20MG","12","Select","Select",""],["","11822059042","MUCUS ","60-600MG","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":""}]}]}