{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SUSAN   J EASTER","gend":1,"add":"12227 HIDEAWAY LN","city":"CARROLLTON","state":"VA","zip":"23314-9998","dob":"1965-07-16","age":"","mstatus":"","insh":"6192513*01","cliId":"","pno":"357-5329","cno":"357-5329","email":"","ename":"","eno":"","pphy":"DUMARAN, RAYMOND MD","ppno":"757\/484-5828","pcpadd":"7185 HARBOUR TOWNE PKWY SUITE 206","pcpcity":"SUFFOLK","pcpstate":"VA","pcpzip":23435,"pcpcounty":"","pcpid":162911,"pcpname":"INTERNISTS OF CHURCHLAND","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"686-3051","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/484-4933","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E03.9","Z00.00","R91.8","K76.0","E04.2","R06.02","R49.0","J30.1","H69.83","K21.9","D38.1","J34.3","D3A.090","R94.2","R91.1","R05.","C7A.090","I10.","K59.00","Z88.1","Z91.012","Z91.011","Z84.1","Z82.49","Z83.3","Z82.0","Z79.890","Z79.899","Z09.","Z86.012","Z98.890","Z12.31","R06.00","J93.9","Z85.118","Z86.010","R93.89","K44.9","K20.80","K63.5","Z01.818","Z46.82","H66.90","R59.0","R94.31","J98.2","R06.2","J40.","R22.2","Z48.812","E55.9","D12.6","E66.9","E78.5","G47.00","Z68.30","R10.13","Z68.31","E07.9"],"date":["2021-07-20","2021-03-08","2021-07-14","2021-03-10","2021-04-02","2021-05-10","2021-05-27","2021-05-27","2021-05-27","2021-07-20","2021-05-27","2021-05-27","2021-08-03","2021-06-03","2021-07-06","2021-06-03","2021-07-20","2021-07-20","2021-07-13","2021-07-13","2021-07-13","2021-07-13","2021-07-13","2021-07-13","2021-07-13","2021-07-13","2021-07-13","2021-07-13","2021-08-03","2021-08-03","2021-08-03","2021-03-09","2021-03-18","2021-07-15","2021-03-31","2021-04-26","2021-04-26","2021-05-26","2021-04-26","2021-04-26","2021-05-07","2021-07-14","2020-05-15","2021-05-26","2021-07-06","2021-07-13","2021-06-01","2021-06-01","2021-06-03","2021-08-03","2020-02-26","2021-04-26","2021-03-08","2021-03-08","2020-02-26","2020-02-26","2021-03-08","2021-03-08","2021-05-12"],"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":[["","00074518290","SYNTHROID ","75MCG","90","Select","Select",""],["","55111015810","OMEPRAZOLE ","20MG","60","Select","Select",""],["","69097081312","GABAPENTIN ","100MG","90","Select","Select",""],["","52817032000","BACLOFEN ","10MG","90","Select","Select",""],["","10702001801","OXYCODONE ","5MG","42","Select","Select",""],["","00591042405","TRIAMT\/HCTZ ","37.5-25","90","Select","Select",""],["","00781185220","AMOX\/K ","875-125","20","Select","Select",""],["","69547035302","NARCAN ","","-2","Select","Select",""],["","59267100001","PFIZER ","COVID-19","0","Select","Select",""],["","00093317431","ALBUTEROL ","HFA","8","Select","Select",""],["","23155013525","DOXYCYC ","100MG","20","Select","Select",""],["","69238183207","LEVOTHYROXIN ","75MCG","90","Select","Select",""],["","60505083001","MOMETASONE ","50MCG","17","Select","Select",""],["","00591042405","TRIAMT\/HCTZ","37.5-25","90","Select","Select",""],["","00074518290","SYNTHROID","75MCG","-90","Select","Select",""],["","00781185220","AMOX\/K","875-125","20","Select","Select",""],["","55111064505","OMEPRAZOLE","40MG","90","Select","Select",""],["","00093317431","ALBUTEROL","HFA","8","Select","Select",""],["","23155013525","DOXYCYC","100MG","20","Select","Select",""],["","60505083001","MOMETASONE","50MCG","17","Select","Select",""],["","59267100001","PFIZER","COVID-19","0","Select","Select",""],["","69547035302","NARCAN","","2","Select","Select",""],["","52817032000","BACLOFEN","10MG","90","Select","Select",""],["","10702001801","OXYCODONE","5MG","42","Select","Select",""],["","69097081312","GABAPENTIN","100MG","90","Select","Select",""],["","69238183207","LEVOTHYROXIN","75MCG","90","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":""}]}]}