{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JACQUELINE HAILEY","gend":1,"add":"7011 BELVEDERE DR APT A","city":"NEWPORT NEWS","state":"VA","zip":"23607-9998","dob":"1967-06-13","age":"","mstatus":"","insh":"5810167*01","cliId":"","pno":"757\/472-1407","cno":"757\/472-1407","email":"","ename":"","eno":"","pphy":"WEBSTER, ELIZABETH MD","ppno":"757\/975-5200","pcpadd":"7401 WARWICK BLVD","pcpcity":"NEWPORT NEWS","pcpstate":"VA","pcpzip":23607,"pcpcounty":"","pcpid":510019,"pcpname":"","plan":"OHP","program":"ACA","lob":"Individual","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["B34.9","R52.","R35.0","R39.15","E03.9","Z88.8","Z12.31","Z80.3","R07.9","E89.0","F34.1","N76.0","E78.00","Z12.11","I25.10","N62.","N64.4","M54.5","M53.82","M25.512","M25.511","L90.5","R07.89","M54.6","E78.2","K21.9","N63.0","L76.32","Z48.89","K59.00","R14.1","Z28.21","K29.50","D12.6","R14.2","B96.81","R14.0","R68.81","K31.84","R10.13","Z88.3","K31.89","K22.8","D13.0","K44.9","D12.7","H66.92","Z79.890","Z79.899","Z79.82","Z91.041","J02.9","J11.1","M54.9","J31.0","I10.","R06.09","N63.11","N63.15","J32.9","R05.","R51.","R09.81","N60.11","R21.","Z83.3","Z82.49","R10.32","D25.9","Z46.82","U07.1","J12.82","E66.09","R79.89","R09.02","J18.9","J96.01","Z68.33","R06.02","R10.9","Z12.4","R50.9","I51.7","I31.3","R13.12","R09.01","Z20.822","J45.909","E78.5","A41.89","J80.","G92.","R65.20"],"date":["2021-09-08","2020-01-24","2020-01-24","2020-01-24","2021-10-04","2020-03-20","2020-02-11","2020-09-04","2021-09-18","2021-10-13","2021-11-27","2020-08-18","2021-10-04","2021-01-29","2021-10-04","2020-09-09","2020-09-04","2021-08-24","2020-09-04","2020-09-04","2020-09-04","2020-12-08","2020-03-20","2020-05-17","2021-09-21","2021-02-19","2021-02-11","2020-09-21","2020-09-21","2021-08-24","2021-08-24","2021-10-04","2021-01-14","2021-01-29","2021-02-09","2021-02-09","2021-02-09","2021-02-09","2021-02-09","2021-02-09","2020-05-17","2021-01-14","2021-01-14","2021-01-14","2021-01-14","2021-01-29","2021-01-23","2021-09-18","2021-09-18","2021-09-18","2021-09-18","2021-01-23","2020-03-01","2020-03-19","2021-04-20","2021-09-18","2020-03-20","2021-02-11","2021-02-11","2021-08-24","2021-09-14","2020-03-01","2020-03-01","2020-09-04","2020-09-04","2020-09-04","2021-09-18","2021-09-08","2021-09-08","2021-09-19","2021-10-04","2021-09-21","2021-09-21","2021-09-21","2021-09-21","2021-09-21","2021-09-27","2021-09-21","2021-09-22","2021-09-08","2021-09-08","2021-09-14","2021-09-20","2021-09-20","2021-09-24","2021-09-24","2021-09-08","2021-10-04","2021-10-28","2021-09-18","2021-09-18","2021-09-18","2021-09-18"],"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]}},{"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":[["","00456046001","ARMOUR","90MG","-30","Select","Select",""],["","67877047379","LIDOCAINE","5%","35","Select","Select",""],["","69238115403","EZETIMIBE","10MG","30","Select","Select",""],["","68180097501","LEVOTHYROXIN","200MCG","90","Select","Select",""],["","65862019105","CYCLOBENZAPR","10MG","12","Select","Select",""],["","00093310953","AMOXICILLIN","500MG","30","Select","Select",""],["","11822547890","VITAMIN","2000UNIT","30","Select","Select",""],["","27808015601","ROSUVASTATIN","10MG","30","Select","Select",""],["","57896050110","ONE-DAILY","MULT-VIT","100","Select","Select",""],["","64380071206","BENZONATATE","100MG","30","Select","Select",""],["","67877032105","IBUPROFEN","800MG","-45","Select","Select",""],["","31722094101","HYDROCO\/APAP","5-325MG","18","Select","Select",""],["","11822316500","RA","100MG","60","Select","Select",""],["","57237000114","LANSOPR\/AMOX","\/CLARITH","-112","Select","Select",""],["","59746017306","PREDNISONE","10MG","20","Select","Select",""],["","62559025001","ETODOLAC","200MG","-20","Select","Select",""],["","55111015901","OMEPRAZOLE","40MG","30","Select","Select",""],["","65162018910","NAPROXEN","375MG","-40","Select","Select",""],["","00143924920","AMOX\/K","875-125","20","Select","Select",""],["","11822334950","ALLERGY","25MG","24","Select","Select",""],["","59762045001","COLESTIPOL","1GM","-60","Select","Select",""],["","60432026415","FLUTICASONE","50MCG","16","Select","Select",""],["","23155050101","HYDROXYZ","25MG","60","Select","Select",""],["","29300022701","METRONIDAZOL","500MG","14","Select","Select",""],["","10135059230","SIMETHICONE","180MG","60","Select","Select",""],["","00456046001","ARMOUR ","90MG","30","Select","Select",""],["","00093310953","AMOXICILLIN ","500MG","30","Select","Select",""],["","64380071206","BENZONATATE ","100MG","30","Select","Select",""],["","67877047379","LIDOCAINE ","5%","-35","Select","Select",""],["","69238115403","EZETIMIBE ","10MG","30","Select","Select",""],["","23155050101","HYDROXYZ ","25MG","60","Select","Select",""],["","11822334950","ALLERGY ","25MG","24","Select","Select",""],["","27808015601","ROSUVASTATIN ","10MG","30","Select","Select",""],["","65862019105","CYCLOBENZAPR ","10MG","12","Select","Select",""],["","68462019001","NAPROXEN ","500MG","20","Select","Select",""],["","68180096601","LEVOTHYROXIN ","50MCG","90","Select","Select",""],["","31722094101","HYDROCO\/APAP ","5-325MG","18","Select","Select",""],["","29300022701","METRONIDAZOL ","500MG","14","Select","Select",""],["","67877032105","IBUPROFEN ","800MG","45","Select","Select",""],["","11822547890","VITAMIN ","2000UNIT","30","Select","Select",""],["","00143924920","AMOX\/K ","875-125","20","Select","Select",""],["","57896050110","ONE-DAILY ","MULT-VIT","100","Select","Select",""],["","59746017306","PREDNISONE ","10MG","20","Select","Select",""],["","10135059230","SIMETHICONE ","180MG","60","Select","Select",""],["","11822003960","RA ","100MG","60","Select","Select",""],["","62559025001","ETODOLAC ","200MG","-20","Select","Select",""],["","55111015901","OMEPRAZOLE ","40MG","30","Select","Select",""],["","57237000114","LANSOPR\/AMOX ","\/CLARITH","-112","Select","Select",""],["","60432026415","FLUTICASONE ","50MCG","16","Select","Select",""],["","59762045001","COLESTIPOL ","1GM","60","Select","Select",""],["","70010077001","METHOCARBAM ","750MG","90","Select","Select",""],["","00591079401","DICYCLOMINE ","10MG","60","Select","Select",""],["","70010077001","METHOCARBAM","750MG","270","Select","Select",""],["","00591079401","DICYCLOMINE","10MG","-60","Select","Select",""],["","68180096301","ALBUTEROL","HFA","8","Select","Select",""],["","00173071920","FLOVENT","110MCG","12","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","11527075043","SOD","1.10%","100","Select","Select",""],["","00603254021","BUTAL\/APAP","50-325MG","40","Select","Select",""],["","68180096301","ALBUTEROL ","AER HFA","8","Select","Select",""],["","59310057922","PROAIR ","AER ","8","Select","Select",""],["","00173071920","FLOVENT ","AER 110MCG","12","Select","Select",""],["","00603254021","BUTAL\/APAP ","TAB 50-325MG","40","Select","Select",""],["","70461032103","FLUCLVX ","INJ 2021-22","0","Select","Select",""],["","00006483703","PNEUMOVAX ","INJ 25\/0.5","0","Select","Select",""],["","11527075043","SOD ","PST 0.011","100","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":""}]}]}