{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JANET   R BOND","gend":1,"add":"6 HARROWER CT","city":"PORTSMOUTH","state":"VA","zip":"23701-9998","dob":"1963-08-21","age":"","mstatus":"","insh":"8540039*01","cliId":"","pno":"757\/567-2979","cno":"757\/567-2979","email":"","ename":"","eno":"","pphy":"DONALDSON, NICOLE MD","ppno":"757\/227-6866","pcpadd":"SUITE 504 301 RIVERVIEW AVENUE","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23510,"pcpcounty":"","pcpid":161071,"pcpname":"Fort Norfolk Plaza Primary Care","plan":"OHP","program":"ACA","lob":"Individual","region":"TIDEWATER","aligned":"","ano":"757\/567-2979","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/277-0298","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E11.9","R52.","M54.9","R06.02","E66.01","E86.0","H60.399","M79.7","G83.10","G47.33","M54.5","Z12.11","N39.0","R81.","B37.9","R42.","I20.9","R07.9","M48.02","M17.0","G89.4","M62.81","F41.9","R25.9","R49.0","I20.8","R69.","G47.30","Z99.89","Z87.891","E11.65","M51.36","H60.8X1","R29.6","H66.92","K58.2","M54.50","G89.29"],"date":["2021-08-18","2021-08-18","2021-08-18","2020-09-25","2020-10-02","2020-09-25","2020-09-25","2021-08-24","2020-10-02","2021-08-24","2020-03-11","2020-08-31","2020-05-29","2020-05-15","2020-05-15","2020-05-29","2020-06-30","2020-08-06","2021-08-24","2021-08-24","2021-08-24","2021-08-24","2020-03-09","2020-03-10","2020-03-09","2020-08-06","2020-11-19","2020-03-11","2020-03-11","2020-03-11","2021-06-23","2021-11-19","2021-08-18","2021-08-18","2021-08-18","2021-08-18","2021-11-19","2021-11-19"],"priorHcc":[null,null,null,"","","","","","","","","","","","","","","","","","","","","","","","","","","","",null,null,null,null,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":[["","16729017117","AMITRIPTYLIN ","10MG","60","Select","Select",""],["","57237001830","DULOXETINE ","30MG","30","Select","Select",""],["","68382005105","MELOXICAM ","15MG","-30","Select","Select",""],["","70010075401","METHOCARBAM ","500MG","90","Select","Select",""],["","68645057054","CITALOPRAM ","20MG","30","Select","Select",""],["","00093100301","BUSPIRONE ","15MG","60","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","55111014512","FLUCONAZOLE ","150MG","2","Select","Select",""],["","53885024510","ONETOUCH ","ULTRA","100","Select","Select",""],["","00093005805","TRAMADOL ","50MG","28","Select","Select",""],["","69547035302","NARCAN ","","2","Select","Select",""],["","65162047810","NITROFURANTN ","100MG","10","Select","Select",""],["","61570003150","CORTISPORIN ","1%","15","Select","Select",""],["","00168002031","HYDROCORT ","1%","28","Select","Select",""],["","69251020101","OTIPRIO ","60MG\/ML","1","Select","Select",""],["","67877041301","METFORMIN ","500MG ER","90","Select","Select",""],["","68645057290","GLIMEPIRIDE ","2MG","180","Select","Select",""],["","59746017310","PREDNISONE ","10MG","26","Select","Select",""],["","59762134601","PREGABALIN ","75MG","60","Select","Select",""],["","00093505998","ATORVASTATIN ","20MG","90","Select","Select",""],["","16571020150","DICLOFENAC ","75MG DR","60","Select","Select",""],["","50111078751","AZITHROMYCIN ","250MG","6","Select","Select",""],["","00527058601","DICYCLOMINE ","10MG","90","Select","Select",""],["","16729017117","AMITRIPTYLIN","10MG","60","Select","Select",""],["","57237001830","DULOXETINE","30MG","30","Select","Select",""],["","68645057054","CITALOPRAM","20MG","30","Select","Select",""],["","70010075401","METHOCARBAM","500MG","90","Select","Select",""],["","68382005105","MELOXICAM","15MG","30","Select","Select",""],["","00093100301","BUSPIRONE","15MG","-60","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","53885059501","ONETOUCH","30G","100","Select","Select",""],["","65162047810","NITROFURANTN","100MG","10","Select","Select",""],["","55111014512","FLUCONAZOLE","150MG","2","Select","Select",""],["","00093005805","TRAMADOL","50MG","28","Select","Select",""],["","69547035302","NARCAN","","-2","Select","Select",""],["","67877041301","METFORMIN","500MG ER","90","Select","Select",""],["","59746017310","PREDNISONE","10MG","26","Select","Select",""],["","61570003150","CORTISPORIN","1%","15","Select","Select",""],["","00168002031","HYDROCORT","1%","28","Select","Select",""],["","68645057290","GLIMEPIRIDE","2MG","180","Select","Select",""],["","69251020101","OTIPRIO","60MG\/ML","-1","Select","Select",""],["","00093505998","ATORVASTATIN","20MG","90","Select","Select",""],["","59762134601","PREGABALIN","75MG","60","Select","Select",""],["","16571020150","DICLOFENAC","75MG DR","60","Select","Select",""],["","00591079401","DICYCLOMINE","10MG","-90","Select","Select",""],["","50111078751","AZITHROMYCIN","250MG","6","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":""}]}]}