{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"AMY   L SMITH","gend":1,"add":"2309 WINDWARD SHORE DR","city":"VIRGINIA BEACH","state":"VA","zip":"23451-9998","dob":"1973-03-06","pno":"204-4826","cno":"204-4826","email":"","pphy":"BALDERSTON, ROSEMARY MD","ppno":"","pcpadd":"1024 S BATTLEFIELD BLVD","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":23320,"pcpcounty":"","pcpid":120527,"pcpname":"Hanbury Family Medicine","insh":"8186383*02","cliId":"","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"482-5763","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/410-4450","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E03.9","F41.9","G44.89","R20.9","G43.909","H57.10","R63.5","Z76.89","Z71.89","Z01.419","Z30.41","H66.91","G43.109","S01.331A","L08.9","I10.","H92.01","T39.95XA","G44.40","J01.01","E53.8","E78.2","K58.9","A04.9","R14.0","K58.1","J32.0","D72.829","R51.9","J01.90","J02.9"],"date":["2021-02-22","2021-02-22","2021-02-22","2021-02-22","2020-11-11","2020-12-14","2021-04-27","2021-03-04","2021-03-06","2021-04-27","2020-03-05","2021-07-03","2021-02-22","2021-05-27","2021-05-27","2020-11-11","2020-11-11","2020-11-11","2020-11-11","2020-12-09","2020-12-09","2020-12-09","2020-05-14","2020-06-09","2020-05-14","2020-06-09","2020-12-14","2020-12-14","2020-12-14","2021-11-14","2021-11-14"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","",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":[["","43199001101","HYOSCYAMINE","0.125MG","45","Select","Select",""],["","51991074890","DULOXETINE","60MG","30","Select","Select",""],["","00555902742","JUNEL","","63","Select","Select",""],["","68382097001","CHLORTHALID","25MG","-90","Select","Select",""],["","65862007701","CIPROFLOXACN","500MG","14","Select","Select",""],["","64764008060","AMITIZA","8MCG","60","Select","Select",""],["","59651000305","OMEPRAZOLE","40MG","30","Select","Select",""],["","49281042050","FLUZONE","2020-21","0","Select","Select",""],["","68462010530","ONDANSETRON","4MG","30","Select","Select",""],["","69097081312","GABAPENTIN","100MG","90","Select","Select",""],["","59746000103","METHYLPRED","4MG","21","Select","Select",""],["","65862053750","LEVOFLOXACIN","500MG","10","Select","Select",""],["","11534018701","BUT\/APAP\/CAF","","12","Select","Select",""],["","00002143611","EMGALITY","120MG\/ML","1","Select","Select",""],["","00254302802","LUBIPROSTONE","8MCG","60","Select","Select",""],["","65862050320","AMOX\/K","875-125","20","Select","Select",""],["","55111029236","SUMATRIPTAN","50MG","12","Select","Select",""],["","13668013601","ESCITALOPRAM","10MG","30","Select","Select",""],["","60505036301","OFLOXACIN","0.3%OTIC","5","Select","Select",""],["","68180016013","AZITHROMYCIN","250MG","6","Select","Select",""],["","70710113908","FLUCONAZOLE","150MG","2","Select","Select",""],["","43199001101","HYOSCYAMINE ","SUB 0.125MG","45","Select","Select",""],["","68382097001","CHLORTHALID ","TAB 25MG","-90","Select","Select",""],["","51991074890","DULOXETINE ","CAP 60MG","-30","Select","Select",""],["","00555902742","JUNEL ","TAB ","63","Select","Select",""],["","59651000305","OMEPRAZOLE ","CAP 40MG","30","Select","Select",""],["","64764008060","AMITIZA ","CAP 8MCG","-60","Select","Select",""],["","65862007701","CIPROFLOXACN ","TAB 500MG","14","Select","Select",""],["","68462010530","ONDANSETRON ","TAB 4MG","30","Select","Select",""],["","49281042050","FLUZONE ","INJ 2020-21","0","Select","Select",""],["","65862053750","LEVOFLOXACIN ","TAB 500MG","10","Select","Select",""],["","55111029236","SUMATRIPTAN ","TAB 50MG","12","Select","Select",""],["","59746000103","METHYLPRED ","TAB 4MG","21","Select","Select",""],["","00002143611","EMGALITY ","INJ 120MG\/ML","1","Select","Select",""],["","69097081312","GABAPENTIN ","CAP 100MG","90","Select","Select",""],["","65862050320","AMOX\/K ","TAB 875-125","-20","Select","Select",""],["","13668013601","ESCITALOPRAM ","TAB 10MG","30","Select","Select",""],["","11534018701","BUT\/APAP\/CAF ","CAP ","-12","Select","Select",""],["","00254302802","LUBIPROSTONE ","CAP 8MCG","60","Select","Select",""],["","70710113908","FLUCONAZOLE ","TAB 150MG","2","Select","Select",""],["","68180016006","AZITHROMYCIN ","TAB 250MG","4","Select","Select",""],["","60505036301","OFLOXACIN ","DRO 0.3%OTIC","5","Select","Select",""],["","71930002643","BROM\/PSE\/DM ","SYP ","200","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","",""],["No","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":""}]}]}