{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MARK   A EDWARDS","gend":0,"add":"2133 UPTON DR # STE 126-456","city":"VIRGINIA BEACH","state":"VA","zip":"23454-9998","dob":"1959-04-21","age":"","mstatus":"","insh":"7776144*01","cliId":"","pno":"757\/621-7829","cno":"757\/621-7829","email":"","ename":"","eno":"","pphy":"REED, SHARON B MD","ppno":"757\/622-8358","pcpadd":"930 W 21ST ST SUITE 100","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23517,"pcpcounty":"","pcpid":156143,"pcpname":"","plan":"OHP","program":"ACA","lob":"Individual","region":"TIDEWATER","aligned":"","ano":"757\/621-9566","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/622-9662","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I48.0","I47.1","L40.9","E79.0","M54.5","U07.1","R09.02","Z86.39","Z79.01","M54.16","M43.16","M71.38","S32.010A","E11.29","I72.1","E66.01","I10.","I49.3","E78.2","E10.42","R80.9","Z79.4","R74.8","R60.0","K76.0","G47.33","R40.0","R06.83","M19.90","J45.30","Z71.89","M25.50","M62.830","M16.0","J98.4","R06.02","R05.","J12.89","J96.01","E11.42","J45.909","D64.9","L40.50","Z79.899","J30.81","Z91.048","R50.9","J96.00","M48.56XA","M47.816","M48.061","Q76.49","G89.29","I48.91","Z86.16","Z79.51","E11.3293","H40.013","H52.03","H52.223","H52.4","E10.69","E10.40","M22.40","M54.9","W19.XXXA","S39.92XA","M54.6","M25.552","E16.2","Z79.52","M47.817","H25.13","M99.43","S32.018D","Z12.5","Z23.","M51.36","M46.96","E11.9","Z04.3","R52.","M54.89","I48.19","I70.0","I51.7","I08.8","Z12.11","Z98.1","Z01.810","I44.0","M51.16","Z48.89","Z01.818","Z51.81","Z09.","Z20.828","Z68.35","M54.59"],"date":["2021-08-12","2020-02-24","2021-07-29","2020-12-02","2021-09-08","2021-08-13","2020-12-28","2020-12-28","2021-08-12","2021-08-12","2021-08-12","2021-08-12","2021-08-12","2021-07-29","2020-02-25","2021-08-12","2021-08-12","2020-04-17","2021-08-12","2021-03-08","2021-07-29","2021-08-12","2021-06-09","2021-07-29","2021-06-09","2021-08-12","2020-07-01","2020-07-27","2020-10-07","2021-07-29","2020-04-01","2020-11-18","2020-11-20","2020-12-16","2020-12-24","2020-12-24","2020-12-24","2020-12-29","2020-12-24","2021-08-12","2021-03-08","2020-12-24","2021-06-07","2021-08-12","2020-12-24","2021-03-08","2020-12-24","2021-01-07","2021-02-18","2021-08-18","2021-08-12","2021-02-05","2021-02-05","2021-03-08","2021-08-12","2021-08-12","2021-10-25","2020-10-27","2020-06-08","2020-06-08","2020-06-08","2020-07-27","2020-07-27","2020-07-27","2021-08-18","2020-11-15","2020-11-15","2020-11-15","2020-12-16","2020-12-24","2021-02-18","2021-08-18","2021-04-19","2021-02-18","2021-02-18","2021-06-07","2020-12-03","2021-08-18","2020-11-23","2020-11-15","2020-11-15","2020-11-15","2020-11-15","2021-01-11","2021-07-14","2021-07-14","2021-07-14","2021-05-23","2021-08-18","2021-08-09","2021-08-09","2021-08-12","2021-08-13","2021-07-29","2021-07-29","2021-09-08","2021-09-10","2021-08-12","2021-10-11"],"priorHcc":["","","","","",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":[["","00378020810","FUROSEMIDE","20MG","30","Select","Select",""],["","00003089421","ELIQUIS","5MG","60","Select","Select",""],["","00088222033","LANTUS","100\/ML","20","Select","Select",""],["","00093742698","MONTELUKAST","10MG","30","Select","Select",""],["","23155000201","HYDRALAZINE","25MG","180","Select","Select",""],["","68382076010","METFORMIN","1000MG","60","Select","Select",""],["","00378081005","HYDROCHLOROT","12.5MG","30","Select","Select",""],["","68180072003","AMLODIPINE","5MG","-30","Select","Select",""],["","68180051202","LISINOPRIL","2.5MG","30","Select","Select",""],["","00310737020","BUDES\/FORMOT","160-4.5","10","Select","Select",""],["","00186037020","SYMBICORT","160-4.5","-10","Select","Select",""],["","00115521116","COLESTIPOL","1GM","120","Select","Select",""],["","08290328466","INSULIN","0.5\/30G","-200","Select","Select",""],["","50742061610","METOPROL","50MG ER","90","Select","Select",""],["","42806016005","HYDROXYZ","25MG","-60","Select","Select",""],["","70377002911","ATORVASTATIN","40MG","30","Select","Select",""],["","33342006510","VALSARTAN","320MG","30","Select","Select",""],["","00054418625","DEXAMETHASON","6MG","5","Select","Select",""],["","57599080300","FREESTY","2 READER","1","Select","Select",""],["","60505025203","TIZANIDINE","4MG","90","Select","Select",""],["","00378064110","PREDNISONE","10MG","42","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","57599000101","FREESTYLE KIT SENSOR","SENSOR","1","Select","Select",""],["","00591079601","SULFASALAZIN","500MG","-60","Select","Select",""],["","63824005636","MUCINEX","30-600ER","30","Select","Select",""],["","31722094101","HYDROCO\/APAP","5-325MG","-20","Select","Select",""],["","80777027399","MODERNA","COVID-19","0","Select","Select",""],["","69097014260","ALBUTEROL","HFA","7","Select","Select",""],["","60505384901","CELECOXIB","200MG","60","Select","Select",""],["","00378020810","FUROSEMIDE ","20MG","14","Select","Select",""],["","23155000201","HYDRALAZINE ","25MG","60","Select","Select",""],["","50742061610","METOPROL ","50MG ER","30","Select","Select",""],["","00378081005","HYDROCHLOROT ","12.5MG","30","Select","Select",""],["","00003089421","ELIQUIS ","5MG","60","Select","Select",""],["","68382076010","METFORMIN ","1000MG","60","Select","Select",""],["","00115521116","COLESTIPOL ","1GM","120","Select","Select",""],["","70377002911","ATORVASTATIN ","40MG","30","Select","Select",""],["","00093742698","MONTELUKAST ","10MG","30","Select","Select",""],["","00088222033","LANTUS ","100\/ML","20","Select","Select",""],["","68180072003","AMLODIPINE ","5MG","-30","Select","Select",""],["","68180051703","LISINOPRIL ","40MG","30","Select","Select",""],["","10702001150","HYDROXYZ ","25MG","60","Select","Select",""],["","33342006510","VALSARTAN ","320MG","30","Select","Select",""],["","00186037020","SYMBICORT ","160-4.5","10","Select","Select",""],["","00310737020","BUDES\/FORMOT ","160-4.5","10","Select","Select",""],["","08290328466","INSULIN ","0.5\/30G","-200","Select","Select",""],["","31722094101","HYDROCO\/APAP ","5-325MG","-20","Select","Select",""],["","60505025203","TIZANIDINE ","4MG","21","Select","Select",""],["","00054418625","DEXAMETHASON ","6MG","5","Select","Select",""],["","69097014260","ALBUTEROL ","HFA","7","Select","Select",""],["","57599080000","FREESTY ","2 SENSOR","1","Select","Select",""],["","00591079601","SULFASALAZIN ","500MG","60","Select","Select",""],["","63824005636","MUCINEX ","30-600ER","30","Select","Select",""],["","57599000101","FREESTYLE    KIT SENSOR","SENSOR","1","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","80777027399","MODERNA ","COVID-19","0","Select","Select",""],["","60505384901","CELECOXIB ","200MG","60","Select","Select",""],["","00143992801","CIPROFLOXACN ","500MG","10","Select","Select",""],["","00378064110","PREDNISONE ","10MG","42","Select","Select",""],["","76385012350","METHOCARBAM ","500MG","40","Select","Select",""],["","59746000103","METHYLPRED ","4MG","21","Select","Select",""],["","00143992801","CIPROFLOXACN","500MG","10","Select","Select",""],["","76385012350","METHOCARBAM","500MG","40","Select","Select",""],["","59746000103","METHYLPRED","4MG","21","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":""}]}]}