{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"STACY   L FULMER","gend":0,"add":"2909 CHESTNUT AVE","city":"NEWPORT NEWS","state":"VA","zip":"23607-9998","dob":"1968-10-22","age":"","mstatus":"","insh":"2188277*02","cliId":"","pno":"512\/931-1411","cno":"512\/710-8111","email":"","ename":"","eno":"","pphy":"BULLEN, PRISCILLA NP","ppno":"757\/594-4431","pcpadd":"SUITE 4A 12420 WARWICK BLVD","pcpcity":"NEWPORT NEWS","pcpstate":"VA","pcpzip":23606,"pcpcounty":"","pcpid":"","pcpname":"Bruton Avenue Family Practice","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/594-2936","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I10.","E11.9","Z79.4","H93.13","J34.2","H91.91","F41.8","F41.9","R35.1","Z12.11","E11.59","R53.83","R55.","R07.9","R00.2","Z53.21","Z01.818","J98.11","I25.110","I21.4","G47.30","F31.9","E78.5","F17.210","G89.29","Z79.82","Z79.899","Z95.5","R94.39","I25.118","Z23.","Z01.810","E66.01","Z68.33","Z72.0","I25.119","I45.89","R06.09","Z87.891","R16.0","M54.9","E03.9","E78.00","Z53.29","E66.9","I25.2","Z79.02","Z79.890","I25.10","F32.9","I31.3","Z95.1","E87.70","R06.02","I20.0","I20.8","Z48.812","I24.9","E11.65","H90.A31","H90.A22","Z77.122","R07.89","M25.561","M25.511","M25.562","M25.512","G47.00","I34.0","L64.9","R68.82","H81.13","M25.559","Z68.41","Z00.00","Z98.61","Z79.01","Y71.0","T82.855A","I31.4","E87.1","N17.9","D62.","I31.0","I25.82","G47.33","F17.200","Z79.84","Z20.828","E78.2","F06.4","R79.89","D64.9","E55.9","R41.0","E32.0"],"date":["2021-11-23","2021-07-27","2020-07-29","2020-07-08","2021-11-23","2020-07-25","2021-06-30","2021-07-27","2020-03-25","2021-08-30","2020-07-29","2021-11-23","2021-07-02","2021-07-26","2021-07-09","2021-07-09","2021-07-21","2021-07-21","2021-07-30","2020-08-06","2021-07-20","2021-07-20","2021-07-31","2021-06-19","2021-11-23","2021-07-12","2021-06-19","2021-07-12","2020-09-02","2021-07-20","2021-03-31","2021-07-26","2021-11-23","2021-07-12","2020-06-22","2020-08-31","2020-08-06","2020-08-06","2021-07-20","2021-07-10","2021-07-10","2021-07-20","2021-07-20","2021-07-12","2021-07-20","2021-07-12","2021-07-12","2021-07-12","2021-07-31","2021-07-21","2021-07-24","2021-07-31","2021-07-31","2020-08-31","2021-07-23","2021-07-22","2021-07-29","2020-01-21","2020-01-21","2020-07-08","2020-07-08","2020-07-08","2021-07-10","2020-01-25","2021-11-23","2020-01-25","2021-11-23","2020-01-25","2020-08-31","2021-11-23","2021-11-23","2021-11-23","2021-11-23","2021-11-23","2020-01-25","2021-06-19","2021-06-19","2021-07-12","2021-07-20","2021-07-20","2021-07-20","2021-07-20","2021-07-20","2021-07-27","2021-07-20","2020-01-18","2020-01-18","2020-01-18","2020-12-17","2021-06-30","2021-06-30","2021-06-30","2021-06-30","2021-06-30","2021-07-13","2021-07-27"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}}]},{"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":[]},{"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":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","00186077760","BRILINTA","TAB 90MG","180","Select","Select",""],["","65862052890","VENLAFAXINE","CAP 75MG ER","30","Select","Select",""],["","57599000101","FREESTYLE    KIT SENSOR","KIT SENSOR","1","Select","Select",""],["","69097052444","DICLOFENAC","GEL 0.01","100","Select","Select",""],["","08214056080","PEN  NEEDLES","MIS 33GX5\/32","300","Select","Select",""],["","69238183001","LEVOTHYROXIN","TAB 25MCG","90","Select","Select",""],["","00169643810","LEVEMIR","INJ FLEXTOUC","3","Select","Select",""],["","68682036990","DILTIAZEM","CAP 240MG\/24","30","Select","Select",""],["","66733082259","INSULIN","INJ 100\/ML","3","Select","Select",""],["","55111046705","METOPROL","TAB 50MG ER","30","Select","Select",""],["","16729021816","CLOPIDOGREL","TAB 75MG","30","Select","Select",""],["","51991074810","DULOXETINE","CAP 60MG","180","Select","Select",""],["","64380074206","BUSPIRONE","TAB 10MG","90","Select","Select",""],["","62037059990","CARTIA","CAP 240\/24HR","30","Select","Select",""],["","62332038031","TEMAZEPAM","CAP 15MG","30","Select","Select",""],["","43598043501","NITROGLYCERN","SUB 0.3MG","100","Select","Select",""],["","00002879959","HUMALOG","INJ 100\/ML","3","Select","Select",""],["","68382001005","LAMOTRIGINE","TAB 200MG","90","Select","Select",""],["","00002143380","TRULICITY","INJ 0.75\/0.5","2","Select","Select",""],["","13668010401","ISOSORB","TAB 30MG ER","90","Select","Select",""],["","27241011703","FENOFIBRATE","TAB 160MG","90","Select","Select",""],["","68180063709","ATORVASTATIN","TAB 40MG","90","Select","Select",""],["","27241012502","RANOLAZINE","TAB 500MG ER","60","Select","Select",""],["","16729013600","CLONAZEPAM","TAB 0.5MG","30","Select","Select",""],["","72511076002","REPATHA","INJ 140MG\/ML","1","Select","Select",""],["","65162004710","OXYCODONE","TAB 5MG","20","Select","Select",""],["","63304007610","POT  CHLORIDE","TAB 10MEQ ER","10","Select","Select",""],["","69547035302","NARCAN","SPR ","2","Select","Select",""],["","69097081307","GABAPENTIN","CAP 100MG","120","Select","Select",""],["","69315011610","FUROSEMIDE","TAB 20MG","10","Select","Select",""],["","00904675180","ASPIRIN","TAB 81MG EC","60","Select","Select",""],["","60258017101","MAG","TAB 400MG","30","Select","Select",""],["","57896030410","STOOL","TAB 8.6-50MG","40","Select","Select",""],["","80681000300","THEREMS","TAB MULTIVIT","90","Select","Select",""],["","59267100003","PFIZER","INJ COVID-19","0","Select","Select",""],["","29300035505","TRAMADOL","TAB 50MG","28","Select","Select",""],["","57896020110","PAIN","TAB 500MG","80","Select","Select",""],["","13107006101","PHENTERMINE","TAB 37.5MG","30","Select","Select",""],["","31722052630","FINASTERIDE","TAB 1MG","30","Select","Select",""],["","69097042107","CELECOXIB","CAP 200MG","60","Select","Select",""]]}},{"a":[]},{"a":[]},{"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":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":[]}]},{"t":"Mini-Cog","q":[{"a":[]},{"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":"","a13":""}]}]}