{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KEITH PABREZIS","gend":0,"add":"1660 WICOMICO LN PO BOX 3013","city":"VIRGINIA BEACH","state":"VA","zip":"23464-9998","dob":"1972-06-10","age":"","mstatus":"","insh":"1846573*01","cliId":"","pno":"757\/272-5334","cno":"757\/272-5334","email":"","ename":"","eno":"","pphy":"GOINS, BENJAMIN M MD","ppno":"757\/923-9660","pcpadd":"3060 GODWIN BLVD","pcpcity":"SUFFOLK","pcpstate":"VA","pcpzip":23434,"pcpcounty":"","pcpid":122066,"pcpname":"Lakeview Pediatrics & Family Medicine","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/923-9665","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N20.0","R10.9","R31.0","K76.0","J18.9","Z00.00","K21.9","I10.","F31.9","E78.5","L30.9","Z13.220","Z13.1","Z12.11","F51.01"],"date":["2020-08-29","2020-08-29","2020-08-29","2020-08-29","2020-08-29","2020-08-25","2021-08-10","2021-08-10","2020-08-25","2021-08-10","2021-08-10","2021-08-10","2021-08-10","2021-08-10","2021-08-10"],"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":[["","65862062405","GEMFIBROZIL ","600MG","60","Select","Select",""],["","60505257909","ATORVASTATIN ","20MG","90","Select","Select",""],["","29300015001","QUETIAPINE ","200MG","30","Select","Select",""],["","50742061601","METOPROL ","50MG ER","30","Select","Select",""],["","65862039010","ONDANSETRON ","4MG ODT","12","Select","Select",""],["","42858010201","OXYCOD\/APAP ","5-325MG","12","Select","Select",""],["","45802008801","ALBUTEROL ","HFA","8","Select","Select",""],["","62175082032","ESOMEPRA ","20MG DR","90","Select","Select",""],["","65862059801","TAMSULOSIN ","0.4MG","14","Select","Select",""],["","59762305102","AZITHROMYCIN ","1GM PAK","1","Select","Select",""],["","52565005630","TRIAMCINOLON ","0.10%","60","Select","Select",""],["","00115552210","FENOFIBRATE ","160MG","30","Select","Select",""],["","65862062405","GEMFIBROZIL","600MG","180","Select","Select",""],["","60505257909","ATORVASTATIN","20MG","90","Select","Select",""],["","29300015001","QUETIAPINE","200MG","30","Select","Select",""],["","50742061601","METOPROL","50MG ER","30","Select","Select",""],["","65862039010","ONDANSETRON","4MG ODT","12","Select","Select",""],["","42858010201","OXYCOD\/APAP","5-325MG","12","Select","Select",""],["","62175082032","ESOMEPRA","20MG DR","90","Select","Select",""],["","45802008801","ALBUTEROL","HFA","8","Select","Select",""],["","65862059801","TAMSULOSIN","0.4MG","14","Select","Select",""],["","59762305102","AZITHROMYCIN","1GM PAK","1","Select","Select",""],["","00115552210","FENOFIBRATE","160MG","30","Select","Select",""],["","52565005630","TRIAMCINOLON","0.10%","60","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","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Yes","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":""}]}]}