{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"GENA   C YOUNG","gend":1,"add":"2404 PAYNE RD","city":"CHESAPEAKE","state":"VA","zip":"23323-9998","dob":"1963-10-09","age":"","mstatus":"","insh":"5666864*01","cliId":"","pno":"757\/284-9051","cno":"757\/284-9051","email":"","ename":"","eno":"","pphy":"KAPOOR, SONIA MD","ppno":"757\/548-0076","pcpadd":"SUITE 100 725 VOLVO PKWY","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":23320,"pcpcounty":"","pcpid":134965,"pcpname":"Family Physicians of Chesapeake","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"757\/487-3474","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/548-4652","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G89.4","R51.","E78.5","K59.00","M47.812","M75.112","M41.9","M50.30","G47.33","D86.0","J45.909","J30.9","E66.01","M50.322","I10.","N95.2","Z01.419","N39.41","K59.09","I49.9","N39.0","R39.14","Z12.11","N89.8","N20.0","M53.88","M47.817","M96.1","D86.9","R91.8","G47.00","F32.9","Z23.","Z20.828","E66.9","M54.2","M19.90","R10.2","H35.373","H40.1131","H20.013","H04.123","H35.372","B37.2","R15.9","E78.00","B34.9"],"date":["2021-10-14","2020-03-23","2021-11-16","2020-01-20","2021-10-14","2021-10-14","2021-10-14","2021-10-14","2021-11-22","2021-05-20","2021-05-20","2021-05-20","2021-05-20","2020-05-21","2021-11-16","2021-08-26","2021-08-26","2020-08-25","2020-08-25","2020-08-25","2021-08-26","2020-08-25","2021-08-30","2020-09-15","2020-09-15","2021-03-04","2021-03-04","2021-03-04","2020-06-18","2021-05-17","2021-11-16","2021-06-22","2021-11-16","2021-09-19","2021-11-22","2020-05-21","2020-07-22","2020-09-11","2021-03-09","2021-03-09","2021-03-09","2021-03-09","2020-11-04","2021-08-26","2021-08-26","2021-08-26","2021-09-19"],"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":[["","62175048737","VERAPAMIL ","300MG ER","90","Select","Select",""],["","24510005010","NUCYNTA ","50MG","90","Select","Select",""],["","68001035703","METOPROL ","50MG ER","30","Select","Select",""],["","60505025103","TIZANIDINE ","2MG","120","Select","Select",""],["","69097095505","PREGABALIN ","50MG","60","Select","Select",""],["","57237016999","ROSUVASTATIN ","10MG","30","Select","Select",""],["","59310030480","QVAR ","80MCG","11","Select","Select",""],["","69452015120","VITAMIN ","50000UNT","12","Select","Select",""],["","00456120130","LINZESS ","145MCG","30","Select","Select",""],["","00173068220","VENTOLIN ","","18","Select","Select",""],["","00310737020","BUDES\/FORMOT ","160-4.5","31","Select","Select",""],["","00186037020","SYMBICORT ","160-4.5","10","Select","Select",""],["","60505082901","FLUTICASONE ","50MCG","16","Select","Select",""],["","00456315467","AEROCHAMBER ","PLUS","1","Select","Select",""],["","10631000930","KAPSPARGO ","50MG","90","Select","Select",""],["","68001018408","QUETIAPINE ","100MG","90","Select","Select",""],["","00597016061","SPIRIVA ","1.25MCG","4","Select","Select",""],["","00046087221","PREMARIN ","0.625MG","30","Select","Select",""],["","00065175014","ILEVRO ","0.3% OP","3","Select","Select",""],["","66993001968","ALBUTEROL ","HFA","18","Select","Select",""],["","80777027399","MODERNA ","COVID-19","0","Select","Select",""],["","10702002510","PHENTERMINE ","37.5MG","30","Select","Select",""],["","65649030302","XIFAXAN ","550MG","42","Select","Select",""],["","00168009930","KETOCONAZOLE ","2%","30","Select","Select",""],["","24510005010","NUCYNTA","50MG","90","Select","Select",""],["","62175048737","VERAPAMIL","300MG ER","90","Select","Select",""],["","68001035703","METOPROL","50MG ER","30","Select","Select",""],["","60505025103","TIZANIDINE","2MG","120","Select","Select",""],["","59310030480","QVAR","80MCG","11","Select","Select",""],["","69097095505","PREGABALIN","50MG","60","Select","Select",""],["","57237016999","ROSUVASTATIN","10MG","30","Select","Select",""],["","69452015120","VITAMIN","50000UNT","12","Select","Select",""],["","00456120130","LINZESS","145MCG","30","Select","Select",""],["","00173068220","VENTOLIN","","18","Select","Select",""],["","00456315467","AEROCHAMBER","PLUS","1","Select","Select",""],["","60505082901","FLUTICASONE","50MCG","16","Select","Select",""],["","00310737020","BUDES\/FORMOT","160-4.5","31","Select","Select",""],["","68001018408","QUETIAPINE","100MG","90","Select","Select",""],["","00186037020","SYMBICORT","160-4.5","10","Select","Select",""],["","10631000930","KAPSPARGO","50MG","90","Select","Select",""],["","00597016061","SPIRIVA","1.25MCG","4","Select","Select",""],["","00046087221","PREMARIN","0.625MG","30","Select","Select",""],["","00065175014","ILEVRO","0.3% OP","3","Select","Select",""],["","66993001968","ALBUTEROL","HFA","18","Select","Select",""],["","80777027399","MODERNA","COVID-19","0","Select","Select",""],["","10702002510","PHENTERMINE","37.5MG","30","Select","Select",""],["","65649030302","XIFAXAN","550MG","42","Select","Select",""],["","00168009930","KETOCONAZOLE","2%","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":""}]}]}