{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CHELSEA   N DAVIS","gend":1,"add":"1300 FRANKLIN TPKE APT I4","city":"DANVILLE","state":"VA","zip":"24540-9998","dob":"1992-08-05","age":"","mstatus":"","insh":"1461733*01","cliId":"","pno":"434\/441-3608","cno":"434\/441-3608","email":"","ename":"","eno":"","pphy":"STANFIELD, AMY L NP","ppno":"434\/835-0295","pcpadd":"2767 FRANKLIN TURNPIKE","pcpcity":"DANVILLE","pcpstate":"VA","pcpzip":24540,"pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/835-0105","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K21.9","H60.312","J30.89","H60.8X2","R55.","D62.","N93.9","D72.829","I10.","Z86.711","H92.01","N39.0","J30.1","J30.81","J34.3","F42.2","F43.8","Z3A.01","R30.9","F60.5","F41.1","Z63.4","Z59.6","L08.9","L70.9","L02.01","H61.23","I26.99","R06.03","R00.0","O02.1","R13.10","I25.2","Z88.8","J02.9","J00.","Z20.828","B00.1","N89.8","Z11.3","Z32.02","J35.1","N92.6","E61.1","J95.821","I97.121","D50.9","E87.6","R73.9","E83.42","E83.51","R09.81","R30.0","J30.9","J01.90","Z11.59","H60.91","S46.911A","H92.02","R09.2","R60.0","H66.92","H66.002","H92.03","J34.2","J34.89","O88.219","J96.01","I46.9","Z98.890","J35.3","R42.","D64.9","N93.8","R93.89","Z79.01","H60.393","E66.01","H66.91","K08.89","K05.10","J02.8","R59.0","O26.892","R10.2","Z3A.18","N92.1","G47.8","Z76.89","R39.89","H66.90","N30.00","U07.1","Z09.","L98.8","R10.30","O99.512","Z3A.16","G47.30","Z86.74","J03.90","T16.2XXA","B37.9","R39.9","N76.0","B37.3","J06.9","H61.21","T14.8XXA","Z32.01","Z34.90","L85.3","L70.0","J02.0","Y83.8","Y92.238","R59.9","H60.92","T16.9XXA","R22.1","R59.1","V58.89"],"date":["2020-11-23","2021-01-05","2022-05-09","2020-12-13","2021-04-05","2021-04-07","2021-04-05","2021-04-05","2021-04-05","2022-03-04","2022-07-27","2022-09-06","2021-10-28","2021-10-28","2022-01-10","2022-05-06","2022-01-14","2022-02-21","2022-07-20","2022-10-11","2022-10-11","2022-10-11","2022-10-11","2022-02-05","2022-02-05","2022-02-11","2022-02-11","2020-02-25","2020-02-12","2020-02-12","2020-02-12","2020-03-16","2021-06-27","2021-06-27","2022-04-01","2020-06-07","2021-01-28","2020-07-11","2022-06-24","2020-08-17","2020-08-17","2022-04-29","2020-08-27","2020-08-27","2020-02-12","2020-02-12","2020-02-12","2020-02-12","2021-04-05","2020-02-12","2020-02-12","2021-09-10","2021-11-28","2021-12-07","2020-06-30","2020-10-22","2021-07-16","2022-03-08","2022-05-10","2020-02-12","2020-02-17","2020-10-22","2021-08-21","2021-10-18","2022-01-10","2022-01-10","2020-02-14","2020-02-14","2020-02-14","2020-02-14","2020-07-22","2021-04-04","2021-04-04","2021-04-05","2021-04-05","2021-04-05","2021-06-22","2022-06-24","2022-06-25","2022-06-25","2022-06-25","2022-07-27","2022-07-27","2020-01-14","2020-01-14","2020-01-14","2020-02-25","2020-05-14","2020-04-13","2020-04-13","2020-06-15","2020-12-18","2021-01-28","2021-04-07","2021-06-27","2022-07-08","2020-01-01","2020-01-01","2020-03-10","2020-02-27","2020-08-11","2020-10-07","2020-11-17","2022-04-26","2021-09-12","2021-09-12","2020-03-04","2020-07-22","2020-07-27","2021-03-03","2021-03-03","2022-03-14","2022-03-14","2022-04-01","2020-02-12","2020-02-12","2020-07-07","2020-10-03","2020-10-03","2021-06-27","2021-10-18","2022-01-06"],"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":[["","00536100901","FERROUS","TAB 325MG","30","Select","Select",""],["","00093101042","MUPIROCIN","OIN 0.02","22","Select","Select",""],["","51991081403","AZELASTINE","SPR 0.001","30","Select","Select",""],["","50458057930","XARELTO","TAB 20MG","90","Select","Select",""],["","50111033401","METRONIDAZOL","TAB 500MG","14","Select","Select",""],["","69842000101","BUDESONIDE","SUS 32MCG","8","Select","Select",""],["","00527133850","DOXYCYC","TAB 100MG","20","Select","Select",""],["","00603533815","PREDNISONE","PAK 10MG","21","Select","Select",""],["","67877025130","TRIAMCINOLON","CRE 0.001","90","Select","Select",""],["","00299492030","DIFFERIN","GEL 0.001","15","Select","Select",""],["","75826011510","PHENAZOPYRID","TAB 200MG","6","Select","Select",""],["","70710113908","FLUCONAZOLE","TAB 150MG","2","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","10","Select","Select",""],["","65862001501","AMOXICILLIN","TAB 875MG","20","Select","Select",""],["","63304069301","CLINDAMYCIN","CAP 300MG","21","Select","Select",""],["","24208063110","NEO\/POLY\/HC","SOL 1% OTIC","10","Select","Select",""],["","60432074116","ACETIC","SOL 2% OTIC","15","Select","Select",""],["","59267100003","PFIZER","INJ COVID-19","0","Select","Select",""],["","59746000103","METHYLPRED","TAB 4MG","21","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","28","Select","Select",""],["","57896087005","LACTOBACILLU","TAB ","30","Select","Select",""],["","79854010910","ACIDOPHILUS","CAP ","30","Select","Select",""],["","16571041110","CIPROFLOXACN","TAB 250MG","10","Select","Select",""],["","50383077504","LIDOCAINE","SOL 2% VISC","118","Select","Select",""],["","60505079204","ENOXAPARIN","INJ 40\/0.4ML","8","Select","Select",""],["","40985027384","PRENATAL","CAP 200MG","30","Select","Select",""],["","00781618667","CIPRO\/DEXA","SUS 0.3-0.1%","8","Select","Select",""],["","68180071160","CEFDINIR","CAP 300MG","14","Select","Select",""],["","00093598627","EPINEPHRINE","INJ 0.3MG","2","Select","Select",""],["","53489011905","DOXYCYCL","CAP 100MG","20","Select","Select",""],["","45802091987","CETIRIZINE","TAB 10MG","30","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","00378967130","IPRATROPIUM\/","SOL ALBUTER","90","Select","Select",""],["","45802065078","LORATADINE","TAB 10MG","30","Select","Select",""],["","73796045801","COMP","MIS COMP\/NEB","1","Select","Select",""],["","00135061503","FLONASE","SUS 27.5MCG","9","Select","Select",""],["","41100080247","CLARITIN","TAB 10MG","30","Select","Select",""],["","65862050320","AMOX\/K","TAB 875-125","20","Select","Select",""],["","00536101001","DIPHENHIST","CAP 25MG","30","Select","Select",""],["","59779001951","ALLERGY","CAP 25MG","30","Select","Select",""],["","50580072636","ZYRTEC","TAB 10MG","30","Select","Select",""],["","31722070530","VALACYCLOVIR","TAB 1GM","20","Select","Select",""],["","50428047392","CVS","CAP 25MG","30","Select","Select",""],["","51672130406","TERCONAZOLE","CRE 0.004","45","Select","Select",""],["","60505036301","OFLOXACIN","DRO 0.3%OTIC","5","Select","Select",""],["","00065064705","TOBRADEX","SUS 0.3-0.1%","10","Select","Select",""],["","24208029505","TOBRA\/DEXAME","SUS 0.3-0.1%","5","Select","Select",""],["","51672128901","NYSTATIN","CRE 100000","15","Select","Select",""],["","00065853110","CIPRO","SUS OTIC","10","Select","Select",""],["","70461032003","FLUCLVX","INJ 2020-21","0","Select","Select",""],["","49483060450","IBUPROFEN","TAB 800MG","30","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":""}]}]}