{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" BARBARA NELLUM","gend":1,"add":"3127 WESTMINSTER AVE","city":"NORFOLK","state":"VA","zip":"23504-9998","dob":"1963-12-18","age":"","mstatus":"","insh":"6912494*01","cliId":"","pno":"757\/749-7991","cno":"757\/749-7991, 757\/749-7991, ","email":"","ename":"","eno":"","pphy":"NEWBY, JAMES E MD","ppno":"757\/627-6892","pcpadd":"STE 220 930 MAJESTIC AVE","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":"23504-9998","pcpcounty":"","pcpid":100347,"pcpname":"Primary Care Specialists","plan":"OHP - OPTIMA","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":["B20.","E11.65","Z11.3","R05.","K59.00","Z11.59","E10.9","I10.","D50.9","E78.5","D12.4","K64.0","R19.4","K21.9","R09.82","M79.89","R06.02","R07.89","E11.9","E11.40","R20.2","E11.3512","H25.813","E11.3513","E11.3511","R42.","E86.0","Z79.4","Z12.31","B34.9","R06.00","Z20.828","U07.1","I51.7","J02.0","D64.9","Z71.9","H25.812","H25.811","Z13.220","Z23.","L02.91","D52.9","R14.3","Z00.00","J30.9","L60.3","E11.42","J45.909","H43.823","Z96.1","Z85.41","Z91.013","R35.0","Z76.89"],"date":["2021-06-01","2021-06-03","2021-03-11","2020-12-08","2020-02-25","2020-01-06","2021-03-17","2021-06-03","2020-02-19","2020-12-02","2020-03-25","2020-03-25","2020-03-25","2020-08-20","2020-12-08","2020-12-08","2020-08-25","2020-06-11","2020-10-05","2021-06-01","2021-06-01","2021-05-11","2021-03-12","2021-06-08","2021-06-08","2020-11-19","2020-11-19","2020-11-19","2020-12-31","2021-01-29","2021-01-29","2021-03-04","2021-02-12","2020-08-05","2021-03-04","2021-03-04","2021-03-17","2021-03-30","2021-06-08","2021-03-11","2021-04-07","2020-12-02","2020-02-25","2020-02-25","2020-09-24","2020-10-02","2020-12-01","2020-12-01","2020-12-08","2021-04-09","2021-04-09","2020-11-19","2020-11-19","2020-11-19","2021-03-04"],"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":[["","00093720298","PRAVASTATIN","40MG","30","Select","Select",""],["","68180047201","AMLOD\/BENAZP","10-20MG","30","Select","Select",""],["","00254100752","ALBUTEROL","HFA","7","Select","Select",""],["","00378021610","FUROSEMIDE","40MG","-30","Select","Select",""],["","59651000305","OMEPRAZOLE","40MG","30","Select","Select",""],["","64764024060","AMITIZA","24MCG","60","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","58657050016","CODEINE\/GG","10-100\/5","240","Select","Select",""],["","65862056890","MONTELUKAST","5MG","30","Select","Select",""],["","00002879959","HUMALOG","100\/ML","15","Select","Select",""],["","61958250101","BIKTARVY","","30","Select","Select",""],["","67877057505","BENZONATATE","200MG","30","Select","Select",""],["","00088221905","LANTUS","100\/ML","15","Select","Select",""],["","65862052305","GABAPENTIN","600MG","90","Select","Select",""],["","00173052000","SEREVENT","50MCG","-28","Select","Select",""],["","00536100901","FERROUS","325MG","30","Select","Select",""],["","00597019261","STRIVERDI","2.5MCG","4","Select","Select",""],["","00115169449","EPINEPHRINE","0.3MG","-2","Select","Select",""],["","49502050002","EPIPEN","0.3MG","2","Select","Select",""],["","53885027210","ONETOUCH","VERIO","100","Select","Select",""],["","57599000101","FREESTYLE KIT SENSOR","SENSOR","2","Select","Select",""],["","57599000200","FREESTYLE MIS READER","READER","1","Select","Select",""],["","00173086910","ANORO","62.5-25","60","Select","Select",""],["","51672130406","TERCONAZOLE","0.40%","45","Select","Select",""],["","00054327099","FLUTICASONE","50MCG","16","Select","Select",""],["","68180012202","CEPHALEXIN","500MG","-28","Select","Select",""],["","00024587102","TOUJEO","300IU\/ML","18","Select","Select",""],["","51991091390","FOLTANX","","60","Select","Select",""],["","00597015230","JARDIANCE","10MG","30","Select","Select",""],["","51991074790","DULOXETINE","30MG","-30","Select","Select",""],["","08373747800","OPTICHAMBER","DIAMOND","-1","Select","Select",""],["","00168000615","TRIAMCINOLON","0.10%","30","Select","Select",""],["","08290320550","BD PEN NEEDL","32GX5\/32","100","Select","Select",""],["","49483060450","IBUPROFEN","800MG","-30","Select","Select",""],["","57237002901","AMOXICILLIN","875MG","20","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":""}]}]}