{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MICHELLE DUNN","gend":1,"add":"914 TOLLARD ST","city":"NORFOLK","state":"VA","zip":"23504-9998","dob":"1970-08-02","age":"","mstatus":"","insh":"8030073*01","cliId":"","pno":"757\/893-0106","cno":"757\/893-0106","email":"","ename":"","eno":"","pphy":"SHAH, DHARMESH K MD","ppno":"757\/543-6861","pcpadd":"710 LIBERTY STREET","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":23324,"pcpcounty":"","pcpid":122310,"pcpname":"","plan":"OHP","program":"ACA","lob":"Individual","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/543-4082","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I10.","E78.5","R73.09","K21.9","M94.262","S83.232D","M24.10","M79.604","S83.231A","E11.9","B37.3","R42.","E66.9","R07.89","R06.02","G44.209","F43.9","E66.01","Z68.42","Z86.718","Z86.711","Z88.0","Z88.8","Z20.828","J01.80","Z12.39","M25.561","H69.83","M25.562","G89.29","S83.232A","Z47.89","R07.1","R51.9","R60.9","R80.9","M89.9","M94.9","J06.9","Z79.899","R09.81","M23.321","M22.41","M84.361A","Z03.818","Z11.59","R39.89","J01.00","B37.9","T36.95XA","M17.12","R13.10","R11.0","K76.0","Z83.71","Z12.11","M17.0","S80.11XA","M25.571","M23.332","M94.8X6","M65.862","L60.0","M79.674","L70.0","L81.0","L83.","S83.241A","S83.191A","M17.11","M25.461","M94.8X8","M76.891","Z00.00","S86.011A","Z01.812","Z01.810","N39.0","M93.862","M83.3","M22.42","M65.9","M23.42","R68.89","J01.90","L30.9","L81.8","Z01.419","M19.90","S86.012A","R73.03","E55.9","R07.9","F43.0","R79.89","Z12.31","M66.361","E03.9","R50.9","S90.811A"],"date":["2021-11-20","2021-11-20","2020-05-30","2021-09-25","2020-04-24","2020-04-17","2020-04-24","2021-08-05","2020-05-29","2021-11-20","2021-11-20","2020-08-15","2020-12-10","2020-10-03","2020-10-03","2020-10-03","2020-10-03","2021-05-12","2020-10-03","2020-10-03","2020-10-03","2020-10-03","2020-10-03","2020-11-20","2020-11-20","2021-03-22","2021-07-06","2021-03-29","2021-07-06","2021-03-29","2020-04-24","2020-05-15","2020-10-03","2021-09-09","2021-05-18","2021-09-25","2020-01-17","2020-01-17","2020-06-12","2020-01-31","2020-01-31","2020-06-05","2020-06-05","2020-06-05","2020-09-11","2020-09-11","2020-07-31","2020-07-31","2020-07-31","2020-07-31","2021-07-08","2021-05-12","2021-05-12","2021-05-12","2021-05-12","2021-05-23","2021-07-06","2021-07-08","2021-07-15","2020-01-15","2020-01-15","2020-01-15","2021-10-06","2021-05-28","2021-11-04","2021-09-16","2021-05-13","2020-05-29","2020-05-29","2020-05-29","2020-05-29","2020-05-29","2020-05-29","2021-01-08","2021-07-15","2020-01-03","2020-01-03","2021-10-26","2020-01-15","2020-01-15","2020-01-15","2020-01-15","2020-01-15","2020-06-12","2020-06-16","2021-03-18","2021-11-04","2021-06-07","2021-08-05","2021-07-15","2020-07-27","2021-11-20","2020-10-03","2020-10-03","2020-10-03","2021-03-22","2021-10-06","2021-09-25","2021-10-26","2021-11-03"],"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":[["","68382005105","MELOXICAM ","15MG","-30","Select","Select",""],["","16729017317","AMITRIPTYLIN ","50MG","31","Select","Select",""],["","75834015801","VERAPAMIL ","180MG ER","31","Select","Select",""],["","00527144501","PHENTERMINE ","37.5MG","45","Select","Select",""],["","68180047803","SIMVASTATIN ","10MG","90","Select","Select",""],["","68645014059","FAMOTIDINE ","20MG","30","Select","Select",""],["","64380073706","VITAMIN ","50000UNT","12","Select","Select",""],["","70069000510","CYANOCOBALAM ","1000MCG","3","Select","Select",""],["","31722063231","OSELTAMIVIR ","75MG","10","Select","Select",""],["","00713063437","MOMETASONE ","0.10%","45","Select","Select",""],["","55111018015","TIZANIDINE ","4MG","120","Select","Select",""],["","59746012106","MECLIZINE ","25MG","90","Select","Select",""],["","00574220520","TRETINOIN ","0.05%","40","Select","Select",""],["","68382004101","PROMETHAZINE ","25MG","90","Select","Select",""],["","55111014601","FLUCONAZOLE ","200MG","-2","Select","Select",""],["","00781728750","CLINDAMY\/BEN ","1-5%","50","Select","Select",""],["","47781030301","NITROFURANTN ","100MG","10","Select","Select",""],["","00591352530","LIDOCAINE ","5%","30","Select","Select",""],["","16837085550","PEPCID ","20MG","30","Select","Select",""],["","31722071390","PANTOPRAZOLE ","40MG","90","Select","Select",""],["","00121077508","GG\/CODEINE ","100-10\/5","180","Select","Select",""],["","50111078751","AZITHROMYCIN ","250MG","6","Select","Select",""],["","65162083366","DICLOFENAC ","1%","100","Select","Select",""],["","59746017509","PREDNISONE ","20MG","12","Select","Select",""],["","00527147701","DIETHYLPROP ","75MG ER","30","Select","Select",""],["","43547040111","FUROSEMIDE ","20MG","120","Select","Select",""],["","69543025216","VIRTUSSIN ","100-10\/5","240","Select","Select",""],["","29300022019","MONTELUKAST ","10MG","31","Select","Select",""],["","49281042050","FLUZONE ","2020-21","0","Select","Select",""],["","58657050004","CODEINE\/GG ","10-100\/5","240","Select","Select",""],["","00781286810","OMEPRAZOLE ","20MG","90","Select","Select",""],["","68645058259","METFORMIN ","500MG","180","Select","Select",""],["","00143924920","AMOX\/K ","875-125","20","Select","Select",""],["","58160082311","SHINGRIX ","50\/0.5ML","-1","Select","Select",""],["","00781261305","AMOXICILLIN ","500MG","21","Select","Select",""],["","00406012301","HYDROCO\/APAP ","5-325MG","42","Select","Select",""],["","49035056314","ASPIRIN ","81MG EC","28","Select","Select",""],["","49035037730","EQ ","8.6-50MG","30","Select","Select",""],["","00378427577","VALACYCLOVIR ","500MG","20","Select","Select",""],["","00713065540","TRIAMCINOLON ","DEN 0.1%","5","Select","Select",""],["","00116200116","CHLORHEX ","0.12%","473","Select","Select",""],["","51293081101","PHENAZOPYRID ","200MG","9","Select","Select",""],["","59267100001","PFIZER ","COVID-19","0","Select","Select",""],["","00093005805","TRAMADOL ","50MG","14","Select","Select",""],["","43386016901","POT  CHLORIDE","20%","473","Select","Select",""],["","65162019011","NAPROXEN ","500MG","60","Select","Select",""],["","16571041210","CIPROFLOXACN ","500MG","14","Select","Select",""],["","42806040021","METHYLPRED ","4MG","21","Select","Select",""],["","00904672080","ACETAMIN ","500MG","120","Select","Select",""],["","42806071401","BENZONATATE ","100MG","30","Select","Select",""],["","00054327099","FLUTICASONE ","50MCG","16","Select","Select",""],["","00713063437","MOMETASONE","0.10%","45","Select","Select",""],["","49035056314","ASPIRIN","81MG EC","28","Select","Select",""],["","00406012301","HYDROCO\/APAP","5-325MG","42","Select","Select",""],["","49035037730","EQ","8.6-50MG","30","Select","Select",""],["","68645014059","FAMOTIDINE","20MG","30","Select","Select",""],["","16729017317","AMITRIPTYLIN","50MG","31","Select","Select",""],["","75834015801","VERAPAMIL","180MG ER","31","Select","Select",""],["","00574220545","TRETINOIN","0.05%","-45","Select","Select",""],["","70069000510","CYANOCOBALAM","1000MCG","1","Select","Select",""],["","68382004101","PROMETHAZINE","25MG","90","Select","Select",""],["","64380073706","VITAMIN","50000UNT","4","Select","Select",""],["","31722063231","OSELTAMIVIR","75MG","10","Select","Select",""],["","59746012106","MECLIZINE","25MG","90","Select","Select",""],["","00527147701","DIETHYLPROP","75MG ER","30","Select","Select",""],["","55111014601","FLUCONAZOLE","200MG","2","Select","Select",""],["","00591352530","LIDOCAINE","5%","-30","Select","Select",""],["","00713065540","TRIAMCINOLON","DEN 0.1%","5","Select","Select",""],["","00116200116","CHLORHEX","0.12%","473","Select","Select",""],["","47781030301","NITROFURANTN","100MG","10","Select","Select",""],["","16837085550","PEPCID","20MG","30","Select","Select",""],["","51224010150","PHENTERMINE","37.5MG","-45","Select","Select",""],["","55111018015","TIZANIDINE","4MG","20","Select","Select",""],["","69543025216","VIRTUSSIN","100-10\/5","140","Select","Select",""],["","00121077508","GG\/CODEINE","100-10\/5","180","Select","Select",""],["","50111078751","AZITHROMYCIN","250MG","6","Select","Select",""],["","43547040111","FUROSEMIDE","20MG","120","Select","Select",""],["","29300022019","MONTELUKAST","10MG","31","Select","Select",""],["","00093005805","TRAMADOL","50MG","14","Select","Select",""],["","68645058259","METFORMIN","500MG","180","Select","Select",""],["","00904672080","ACETAMIN","500MG","120","Select","Select",""],["","00143924920","AMOX\/K","875-125","20","Select","Select",""],["","58657050004","CODEINE\/GG","10-100\/5","-240","Select","Select",""],["","49281042050","FLUZONE","2020-21","0","Select","Select",""],["","42806071401","BENZONATATE","100MG","30","Select","Select",""],["","43386016901","POT CHLORIDE","20%","473","Select","Select",""],["","00781286810","OMEPRAZOLE","20MG","90","Select","Select",""],["","16714068203","SIMVASTATIN","10MG","90","Select","Select",""],["","58160082311","SHINGRIX","50\/0.5ML","1","Select","Select",""],["","00378427577","VALACYCLOVIR","500MG","20","Select","Select",""],["","65162068210","PHENAZOPYRID","200MG","9","Select","Select",""],["","65162083366","DICLOFENAC","1%","100","Select","Select",""],["","16571041210","CIPROFLOXACN","500MG","14","Select","Select",""],["","68382005005","MELOXICAM","7.5MG","30","Select","Select",""],["","59267100001","PFIZER","COVID-19","0","Select","Select",""],["","00054327099","FLUTICASONE","50MCG","16","Select","Select",""],["","00781728750","CLINDAMY\/BEN","1-5%","-50","Select","Select",""],["","59746017509","PREDNISONE","20MG","12","Select","Select",""],["","31722071390","PANTOPRAZOLE","40MG","90","Select","Select",""],["","65162019011","NAPROXEN","500MG","60","Select","Select",""],["","00781261305","AMOXICILLIN","500MG","21","Select","Select",""],["","67405083008","BENZOYL","10% WASH","-237","Select","Select",""],["","68382055901","NITROFUR","50MG","30","Select","Select",""],["","42806040021","METHYLPRED","4MG","21","Select","Select",""],["","00145098505","PANOXYL","10%","237","Select","Select",""],["","00832532511","POT CL MICRO","20MEQ ER","180","Select","Select",""],["","51672137303","TAZAROTENE","0.10%","60","Select","Select",""],["","67877021905","CEPHALEXIN","500MG","20","Select","Select",""],["","51672137303","TAZAROTENE ","CRE 0.001","-60","Select","Select",""],["","67405083008","BENZOYL ","LIQ 10% WASH","237","Select","Select",""],["","68382055901","NITROFUR ","CAP 50MG","30","Select","Select",""],["","67877021905","CEPHALEXIN ","CAP 500MG","20","Select","Select",""],["","00145098505","PANOXYL ","LIQ 0.1","237","Select","Select",""],["","00832532511","POT  CL MICRO","TAB 20MEQ ER","180","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":""}]}]}