{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"PAMELA   M WELLS","gend":1,"add":"8410 OLD OCEAN VIEW RD","city":"NORFOLK","state":"VA","zip":"23518-9998","dob":"1968-12-13","age":"","mstatus":"","insh":"6063926*02","cliId":"","pno":"757\/592-1308","cno":"757\/592-1308","email":"","ename":"","eno":"","pphy":"MILLER, JULIUS S MD","ppno":"757\/547-9286","pcpadd":"113 GAINSBOROUGH SQ STE 300","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":23320,"pcpcounty":"","pcpid":210342,"pcpname":"Bayview Hospitalist","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"449-5617","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":["R07.89","I47.1","Z95.818","Z79.899","Z87.891","Z88.5","Z88.0","R06.02","E55.9","E83.42","S82.851A","S93.431A","Z20.828","R05.","R50.9","M79.7","I05.9","G43.909","R00.2","F41.9","L91.8","Z71.9","Z28.21","Z20.822","R42.","R26.9","J45.21","J44.1","R11.0","J45.20","R09.82","M79.662","J06.9"],"date":["2020-07-10","2021-07-13","2020-07-10","2020-07-10","2021-01-01","2021-01-01","2021-01-01","2020-11-20","2021-02-24","2021-01-08","2020-01-29","2020-06-03","2021-01-22","2020-11-30","2020-11-30","2021-02-24","2021-02-24","2021-02-24","2021-07-13","2021-02-24","2020-05-04","2020-05-04","2020-05-04","2021-01-22","2020-07-22","2020-06-03","2020-11-20","2020-11-24","2021-01-08","2021-07-13","2020-11-20","2021-01-01","2020-01-03"],"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":[["","00574402435","ERYTHROMYCIN","5MG\/GM","-4","Select","Select",""],["","00054004641","IPRATROPIUM","0.06%","15","Select","Select",""],["","62542030117","HYD","10-8\/5ML","70","Select","Select",""],["","00591544305","PREDNISONE","20MG","10","Select","Select",""],["","00254100752","ALBUTEROL","HFA","7","Select","Select",""],["","00173068220","VENTOLIN","","18","Select","Select",""],["","64380080707","IBUPROFEN","800MG","-30","Select","Select",""],["","16729013616","CLONAZEPAM","0.5MG","60","Select","Select",""],["","45963067611","METOPROLOL","50MG ER","90","Select","Select",""],["","68462015713","ONDANSETRON","4MG ODT","50","Select","Select",""],["","68382050010","OMEPRAZOLE","40MG","90","Select","Select",""],["","69452015120","VITAMIN","50000UNT","-4","Select","Select",""],["","53489012002","DOXYCYCL","100MG","14","Select","Select",""],["","62037083101","METOPROL","50MG ER","90","Select","Select",""],["","00591024005","LORAZEPAM","0.5MG","12","Select","Select",""],["","69097084705","ESCITALOPRAM","5MG","30","Select","Select",""],["","62542030117","HYD ","10-8\/5ML","70","Select","Select",""],["","00574402435","ERYTHROMYCIN ","5MG\/GM","4","Select","Select",""],["","00591544305","PREDNISONE ","20MG","10","Select","Select",""],["","00054004641","IPRATROPIUM ","0.06%","15","Select","Select",""],["","00254100752","ALBUTEROL ","HFA","7","Select","Select",""],["","00173068220","VENTOLIN ","","18","Select","Select",""],["","64380080707","IBUPROFEN ","800MG","30","Select","Select",""],["","16729013616","CLONAZEPAM ","0.5MG","-60","Select","Select",""],["","62037083101","METOPROL ","50MG ER","90","Select","Select",""],["","00591024005","LORAZEPAM ","0.5MG","12","Select","Select",""],["","45963067611","METOPROLOL ","50MG ER","-90","Select","Select",""],["","53489012002","DOXYCYCL ","100MG","14","Select","Select",""],["","69452015120","VITAMIN ","50000UNT","-4","Select","Select",""],["","68382050010","OMEPRAZOLE ","40MG","-90","Select","Select",""],["","68462015713","ONDANSETRON ","4MG ODT","-50","Select","Select",""],["","69097084705","ESCITALOPRAM ","5MG","-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":""}]}]}