{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DEANNA WHITLEY","gend":1,"add":"3312 ZURICH ARCH","city":"VIRGINIA BEACH","state":"VA","zip":"23452-9998","dob":"1977-11-19","age":"","mstatus":"","insh":"6967329*01","cliId":"","pno":"757\/304-2750","cno":"757\/304-2750","email":"","ename":"","eno":"","pphy":"PATEL, JITENDRA MD","ppno":"757\/471-3100","pcpadd":"2020S INDEPENDENCE SUITE 1","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23456,"pcpcounty":"","pcpid":101215,"pcpname":"Family and Internal Medical Center","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"468-4245","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/471-3624","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["H47.11","Z79.899","G44.89","H47.10","L73.2","I10.","N91.1","A63.0","R87.619","E78.00","D64.9","R73.09","Z01.419","M54.5","M77.11","E55.9","E03.9","H16.223","H52.13","M54.9","M25.521","D50.9","R76.0","E06.3","L60.3","L82.0","R07.9","Z01.411","L74.8","G47.00","R53.83","E23.6","R51.","B37.3","E78.5","L30.4","R51.9","E74.39","E78.2","M54.2","K42.9","E34.8","G93.5","M35.9","R10.9","N83.201","Z90.49"],"date":["2021-07-07","2021-08-31","2021-07-07","2021-09-03","2021-08-31","2021-06-24","2021-06-24","2021-07-30","2021-06-24","2021-02-18","2020-01-10","2021-03-04","2020-01-15","2020-01-30","2020-02-24","2021-09-03","2021-09-03","2021-07-07","2021-07-07","2021-09-03","2020-01-30","2020-02-06","2021-02-02","2021-08-31","2020-11-18","2020-11-18","2020-05-23","2021-05-24","2021-05-24","2021-05-24","2021-05-24","2021-09-03","2020-03-05","2020-11-16","2021-03-04","2020-11-02","2021-09-03","2021-09-03","2021-09-03","2021-09-03","2021-09-27","2021-09-03","2021-09-03","2021-08-31","2021-09-20","2021-09-20","2021-09-20"],"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":[["","00781519192","LEVOTHYROXIN ","137MCG","30","Select","Select",""],["","68645056259","IBUPROFEN ","600MG","90","Select","Select",""],["","29033003001","ACETAZOLAMID ","500MG ER","60","Select","Select",""],["","55111015930","OMEPRAZOLE ","40MG","30","Select","Select",""],["","55111014512","FLUCONAZOLE ","150MG","1","Select","Select",""],["","43598072101","HYDROXYCHLOR ","200MG","60","Select","Select",""],["","16571040250","CETIRIZINE ","10MG","30","Select","Select",""],["","65862044830","VALACYCLOVIR ","500MG","60","Select","Select",""],["","65162062711","TRAMADOL ","50MG","14","Select","Select",""],["","16714068403","SIMVASTATIN ","40MG","30","Select","Select",""],["","68462019005","NAPROXEN ","500MG","60","Select","Select",""],["","00591544210","PREDNISONE ","10MG","30","Select","Select",""],["","51862006405","DIAZEPAM ","10MG","1","Select","Select",""],["","00228202950","ALPRAZOLAM ","0.5MG","2","Select","Select",""],["","72305013730","EUTHYROX ","137MCG","30","Select","Select",""],["","45802056201","CLINDAMYCIN ","1%","30","Select","Select",""],["","00045020444","ZYRTEC ","10MG","30","Select","Select",""],["","16571020210","DICLOFENAC ","50MG DR","20","Select","Select",""],["","00093312501","DICLOXACILL ","500MG","20","Select","Select",""],["","00299383645","METROCREAM ","0.75%","45","Select","Select",""],["","51672127401","BETAMETH ","0.05%","30","Select","Select",""],["","00574061105","PODOFILOX ","0.50%","4","Select","Select",""],["","00074055402","HUMIRA ","40\/0.4ML","4","Select","Select",""],["","68462062652","AZELAIC ","15%","50","Select","Select",""],["","00023611803","CONDYLOX ","0.50%","4","Select","Select",""],["","64380073706","VITAMIN ","50000UNT","12","Select","Select",""],["","70515061001","PRILOSEC ","10MG","90","Select","Select",""],["","00316022130","NYSTATIN ","100000","30","Select","Select",""],["","45802014167","CICLOPIROX ","8%","7","Select","Select",""],["","53489012002","DOXYCYCL ","100MG","60","Select","Select",""],["","66993096045","METRONIDAZOL ","0.75%","45","Select","Select",""],["","67877025145","TRIAMCINOLON ","0.10%","454","Select","Select",""],["","65162027250","SMZ\/TMP ","800-160","20","Select","Select",""],["","00093101042","MUPIROCIN ","2%","22","Select","Select",""],["","43598021040","SSD ","1%","400","Select","Select",""],["","49035045875","ALLERGY ","10MG","90","Select","Select",""],["","16714068403","SIMVASTATIN","40MG","30","Select","Select",""],["","55111015930","OMEPRAZOLE","40MG","30","Select","Select",""],["","00781519192","LEVOTHYROXIN","137MCG","30","Select","Select",""],["","00093005805","TRAMADOL","50MG","60","Select","Select",""],["","16571040250","CETIRIZINE","10MG","30","Select","Select",""],["","43598072101","HYDROXYCHLOR","200MG","60","Select","Select",""],["","55111014512","FLUCONAZOLE","150MG","1","Select","Select",""],["","65862044830","VALACYCLOVIR","500MG","60","Select","Select",""],["","68645056259","IBUPROFEN","600MG","90","Select","Select",""],["","68462019005","NAPROXEN","500MG","60","Select","Select",""],["","29033003001","ACETAZOLAMID","500MG ER","60","Select","Select",""],["","00228202950","ALPRAZOLAM","0.5MG","2","Select","Select",""],["","72305013730","EUTHYROX","137MCG","30","Select","Select",""],["","00093312501","DICLOXACILL","500MG","20","Select","Select",""],["","16571020210","DICLOFENAC","50MG DR","20","Select","Select",""],["","00045020444","ZYRTEC","10MG","30","Select","Select",""],["","64380073706","VITAMIN","50000UNT","12","Select","Select",""],["","00316022130","NYSTATIN","100000","30","Select","Select",""],["","45802056201","CLINDAMYCIN","1%","30","Select","Select",""],["","00074012403","HUMIRA","CD\/UC\/HS","3","Select","Select",""],["","45802014167","CICLOPIROX","8%","7","Select","Select",""],["","53489012002","DOXYCYCL","100MG","60","Select","Select",""],["","00299383645","METROCREAM","0.75%","45","Select","Select",""],["","67877025145","TRIAMCINOLON","0.10%","454","Select","Select",""],["","66993096045","METRONIDAZOL","0.75%","45","Select","Select",""],["","68462062652","AZELAIC","15%","50","Select","Select",""],["","51672127401","BETAMETH","0.05%","30","Select","Select",""],["","00023611803","CONDYLOX","0.50%","4","Select","Select",""],["","68462056435","MUPIROCIN","2%","30","Select","Select",""],["","00574061105","PODOFILOX","0.50%","4","Select","Select",""],["","70515061001","PRILOSEC","10MG","90","Select","Select",""],["","43598021040","SSD","1%","400","Select","Select",""],["","49035045875","ALLERGY","10MG","90","Select","Select",""],["","00591544210","PREDNISONE","10MG","30","Select","Select",""],["","51862006405","DIAZEPAM","10MG","1","Select","Select",""],["","65162027250","SMZ\/TMP","800-160","20","Select","Select",""],["","59267100002","PFIZER","COVID-19","0","Select","Select",""],["","59267100002","PFIZER ","INJ COVID-19","0","Select","Select",""],["","67877022310","GABAPENTIN ","CAP 300MG","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":""}]}]}