{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"FATIMA   S TOMLIN","gend":1,"add":"4765 ALICIA DR # 527","city":"VIRGINIA BEACH","state":"VA","zip":"23462-9998","dob":"1976-03-15","age":"","mstatus":"","insh":"8876436*01","cliId":"","pno":"757\/235-9471","cno":"757\/235-9471","email":"","ename":"","eno":"","pphy":"RIEDLER, SYLVIA H MD","ppno":"757\/481-1113","pcpadd":"STE 201 1168 FIRST COLONIAL R","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23454,"pcpcounty":"","pcpid":144668,"pcpname":"Va Beach Internal Medicine","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/496-3822","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J18.9","R50.81","R06.02","Z71.89","Z20.822","J15.9","J96.01","N76.0","R91.8","A40.3","E55.9","R73.01","E20.9","E83.51","Z88.1","Z88.2","R52.","A41.9","Z78.9","R06.03","R06.82","R50.9","D47.3","R94.5","Z20.2","Z72.51","B37.3","R30.9","R31.9","Z12.31","J18.1","R09.02","Z01.419","Z12.39","Z12.12","R79.89","R07.9","I10.","J45.909","E03.9","Z90.710","Z79.890","Z79.51","Z00.00","Z87.440","F41.9","Z12.11"],"date":["2021-07-19","2021-04-05","2021-04-10","2021-04-05","2021-04-10","2021-04-09","2021-04-15","2021-02-05","2021-06-02","2021-04-10","2021-03-22","2021-03-22","2021-03-22","2021-03-22","2021-04-09","2021-04-09","2021-04-05","2021-04-09","2021-04-09","2021-04-09","2021-04-09","2021-04-10","2021-07-19","2021-05-24","2020-10-03","2020-10-03","2021-04-27","2021-06-30","2021-06-30","2021-02-10","2021-04-09","2021-04-14","2020-12-09","2021-03-24","2020-12-09","2021-04-05","2021-04-05","2021-04-10","2021-04-10","2021-04-10","2021-04-10","2021-04-10","2021-04-10","2021-07-19","2021-07-19","2021-07-19","2021-07-19"],"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":[["","51862094205","DIAZEPAM ","5MG","6","Select","Select",""],["","31722072690","MONTELUKAST ","10MG","90","Select","Select",""],["","57237000511","FLUCONAZOLE ","150MG","-2","Select","Select",""],["","13668033005","TRAZODONE ","50MG","-30","Select","Select",""],["","16729018201","HYDROCHLOROT ","12.5MG","90","Select","Select",""],["","00603020922","MAG ","400MG","180","Select","Select",""],["","60846050201","PYRIDIUM ","200MG","9","Select","Select",""],["","65862007701","CIPROFLOXACN ","500MG","14","Select","Select",""],["","65862037401","ESCITALOPRAM ","10MG","-30","Select","Select",""],["","00093314705","CEPHALEXIN ","500MG","20","Select","Select",""],["","69452020720","CALCITRIOL ","0.25MCG","10","Select","Select",""],["","64980033912","MAGNESIUM-OX ","400MG","60","Select","Select",""],["","29300022705","METRONIDAZOL ","500MG","14","Select","Select",""],["","69452015120","VITAMIN ","50000UNT","-36","Select","Select",""],["","00781808926","AZITHROMYCIN ","250MG","6","Select","Select",""],["","65862050320","AMOX\/K ","875-125","4","Select","Select",""],["","00591544305","PREDNISONE ","20MG","-7","Select","Select",""],["","59310057922","PROAIR ","","26","Select","Select",""],["","42806071401","BENZONATATE ","100MG","30","Select","Select",""],["","57237002801","AMOXICILLIN ","500MG","-30","Select","Select",""],["","00093317431","ALBUTEROL ","HFA","26","Select","Select",""],["","65862053750","LEVOFLOXACIN ","500MG","7","Select","Select",""],["","69238183407","LEVOTHYROXIN ","100MCG","90","Select","Select",""],["","00185012201","NITROFURANTN ","100MG","10","Select","Select",""],["","80777027315","MODERNA ","COVID-19","0","Select","Select",""],["","00781214501","AMPICILLIN ","500MG","14","Select","Select",""],["","51862094205","DIAZEPAM","5MG","6","Select","Select",""],["","29300022705","METRONIDAZOL","500MG","14","Select","Select",""],["","16729018201","HYDROCHLOROT","12.5MG","90","Select","Select",""],["","00603020922","MAG","400MG","180","Select","Select",""],["","60846050201","PYRIDIUM","200MG","9","Select","Select",""],["","13668033005","TRAZODONE","50MG","30","Select","Select",""],["","31722072690","MONTELUKAST","10MG","90","Select","Select",""],["","57237000511","FLUCONAZOLE","150MG","2","Select","Select",""],["","65862007701","CIPROFLOXACN","500MG","14","Select","Select",""],["","69097084805","ESCITALOPRAM","10MG","30","Select","Select",""],["","00093314705","CEPHALEXIN","500MG","20","Select","Select",""],["","69452020720","CALCITRIOL","0.25MCG","10","Select","Select",""],["","64980033912","MAGNESIUM-OX","400MG","60","Select","Select",""],["","42806071401","BENZONATATE","100MG","30","Select","Select",""],["","69452015120","VITAMIN","50000UNT","36","Select","Select",""],["","00093317431","ALBUTEROL","HFA","26","Select","Select",""],["","59310057922","PROAIR","","26","Select","Select",""],["","00781808926","AZITHROMYCIN","250MG","6","Select","Select",""],["","65862053750","LEVOFLOXACIN","500MG","7","Select","Select",""],["","57237002801","AMOXICILLIN","500MG","-30","Select","Select",""],["","00591544305","PREDNISONE","20MG","7","Select","Select",""],["","65862050320","AMOX\/K","875-125","4","Select","Select",""],["","69238183407","LEVOTHYROXIN","100MCG","90","Select","Select",""],["","00781214501","AMPICILLIN","500MG","14","Select","Select",""],["","80777027315","MODERNA","COVID-19","0","Select","Select",""],["","00185012201","NITROFURANTN","100MG","10","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":""}]}]}