{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SHAWN   R THOMPSON","gend":1,"add":"9203 GROVE AVE","city":"NORFOLK","state":"VA","zip":"23503-9998","dob":"1957-05-10","age":"","mstatus":"","insh":"20055708*01","cliId":"","pno":"","cno":"","email":"","ename":"","eno":"","pphy":"FORTUNE, JENNIFER BROOKE PA","ppno":"757\/425-8590","pcpadd":"1253 NIMMO PKWY STE 110","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23456,"pcpcounty":"","pcpid":"","pcpname":"EAST BEACH MEDICAL ASSOCIATES","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/422-5107","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R63.6","J44.9","J96.11","R06.03","R06.89","J44.1","J43.9","I11.0","I50.9","J96.21","J96.22","E43.","K44.0","I25.2","Z79.52","Z99.81","Z87.891","R42.","NO DATA","J96.01","R77.8","Z79.2","I10.","Z79.899","R79.89","J96.00","J30.9","R06.09","R91.1","S60.512A","F41.9","Z09.","Z68.1","E44.0","R07.9","J18.9","E87.0","N17.9","R00.0","E86.0","R06.00","Z66.","R64.","Z20.822","Z79.51","K44.9","R00.2","R63.4","I49.9","J96.12","Z01.818","H26.9","Z13.31","H25.813","H40.1132"],"date":["2021-08-25","2021-08-25","2021-08-25","2021-05-31","2021-07-31","2021-08-04","2021-09-02","2021-09-02","2021-09-02","2021-09-02","2021-09-02","2021-09-02","2021-09-02","2021-09-02","2021-09-02","2021-09-02","2021-09-02","2020-01-17","2021-07-07","2021-07-07","2021-07-07","2021-07-07","2021-07-31","2021-07-31","2021-05-29","2021-08-02","2021-08-25","2020-02-14","2021-05-19","2020-04-06","2021-08-10","2021-08-10","2021-08-10","2021-07-30","2021-05-30","2021-05-13","2021-07-31","2021-07-31","2021-07-31","2021-07-31","2021-07-31","2021-07-27","2021-07-27","2021-07-27","2021-07-27","2021-07-27","2020-01-17","2020-01-17","2020-01-17","2019-03-04","2019-08-14","2019-08-14","2019-08-14","2019-06-26","2019-06-26"],"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":{"indx":[false,false],"comment":["",""],"score":["",""]}},{"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":[["","00186037020","SYMBICORT","AER 160-4.5","10","Select","Select",""],["","50111078710","AZITHROMYCIN","TAB 250MG","30","Select","Select",""],["","59746017210","PREDNISONE","TAB 5MG","90","Select","Select",""],["","16714079904","CETIRIZINE","TAB 10MG","30","Select","Select",""],["","00173088210","BREO","INH 200-25","60","Select","Select",""],["","00597010061","SPIRIVA","SPR 2.5MCG","4","Select","Select",""],["","66993058697","FLUTIC\/SALME","AER 500\/50","60","Select","Select",""],["","59267100001","PFIZER","INJ COVID-19","0","Select","Select",""],["","00173089310","TRELEGY","AER ELLIPTA","60","Select","Select",""],["","00173086910","ANORO","AER 62.5-25","60","Select","Select",""],["","16714008210","HYDROXYZ","TAB 25MG","60","Select","Select",""],["","29300022019","MONTELUKAST","TAB 10MG","90","Select","Select",""],["","00085113204","PROVENTIL","AER HFA","7","Select","Select",""],["","69238110002","DOXYCYCL","CAP 100MG","10","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","68180096301","ALBUTEROL","AER HFA","8","Select","Select",""],["","00603107558","CHERATUSSIN","SYP AC","180","Select","Select",""],["","00487020103","IPRATROPIUM\/","SOL ALBUTER","450","Select","Select",""],["","00310737020","BUDES\/FORMOT","AER 160-4.5","10","Select","Select",""],["","69543025216","VIRTUSSIN","SOL 100-10\/5","180","Select","Select",""],["","00228202796","ALPRAZOLAM","TAB 0.25MG","10","Select","Select",""],["","50383008712","GUAIATUSS","SYP 100-10\/5","180","Select","Select",""],["","00173069700","ADVAIR","AER 500\/50","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":""}]}]}