{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"   ECNERWALNAMSSORG M","gend":0,"add":"GIH 9738TS DNALH","city":"NORFOLK","state":"VA","zip":"23518-9998","dob":"1951-08-15","age":"","mstatus":"","insh":"83000910*912","cliId":"6TP6GK0GM59","pno":"65\/7576922-0","cno":"757\/560-2296","email":"","ename":"","eno":"","pphy":"VAN SLYKE, KATHARINE M DO","ppno":"757\/842-6267","pcpadd":"1405 KEMPSVILLE ROAD","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":23320,"pcpcounty":"","pcpid":178852,"pcpname":"COASTAL INTERNAL MEDICINE AND TIDEWATER BARIATRICS","plan":"OHP","program":"MEDICARE","lob":"MA-Non DSNP","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R31.0","R73.03","M53.3","M54.32","M25.552","F32.9","E66.9","Z68.31","N50.819","R31.29","E78.5","Z12.5","H11.32","R19.8","M17.0","M17.11","M17.12","M76.72","M79.672","M51.16","M47.26","M48.061","H43.813","H35.373","Z12.11","Z87.448","N40.1","N52.9","Z68.30","Z03.818","E66.01","L72.9","Z20.828","R53.83","R05.","J01.90","R51.9","M51.26","M25.551","M25.561","M25.562","E55.9","R73.01","H35.363","Z85.47","Z20.822"],"date":["2020-02-20","2021-01-31","2021-02-08","2021-03-05","2021-06-21","2020-04-08","2021-08-31","2021-03-09","2020-01-09","2020-01-09","2021-07-16","2020-12-21","2021-01-27","2021-02-23","2020-11-03","2020-11-03","2020-11-03","2020-11-06","2020-11-06","2021-03-05","2021-03-05","2021-03-05","2021-07-14","2021-07-14","2021-08-31","2020-12-02","2020-12-02","2020-12-02","2020-02-18","2020-12-19","2020-04-08","2020-06-04","2020-11-27","2020-11-27","2020-11-27","2020-11-27","2020-12-19","2021-03-09","2021-06-21","2021-06-21","2021-06-21","2021-07-16","2021-07-16","2021-07-14","2021-08-31","2021-10-03"],"priorHcc":["","","","","","",null,"","","","","","","","","","","","","","","","","",null,"","","","","","","","","","","","","","","","","","","",null,null]}},{"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":[["","63304061650","DOXYCYC ","100MG","-20","Select","Select",""],["","58160082311","SHINGRIX ","50\/0.5ML","1","Select","Select",""],["","70461012003","FLUAD ","0.5ML","0","Select","Select",""],["","47335001083","TADALAFIL ","5MG","90","Select","Select",""],["","69238110005","DOXYCYCL ","100MG","20","Select","Select",""],["","65862059801","TAMSULOSIN ","0.4MG","90","Select","Select",""],["","11822003960","RA ","100MG","4","Select","Select",""],["","11822333000","MAG ","LEMON","296","Select","Select",""],["","52268020101","SUTAB ","","24","Select","Select",""],["","65862019105","CYCLOBENZAPR ","10MG","30","Select","Select",""],["","55566410001","EUFLEXXA ","10MG\/ML","12","Select","Select",""],["","63304061650","","100MG","20","Select","Select",""],["","63304061650","DOXYCYC","100MG","20","Select","Select",""],["","58160082311","SHINGRIX","50\/0.5ML","1","Select","Select",""],["","70461012003","FLUAD","0.5ML","0","Select","Select",""],["","69238110005","DOXYCYCL","100MG","20","Select","Select",""],["","65862059801","TAMSULOSIN","0.4MG","90","Select","Select",""],["","47335001083","TADALAFIL","5MG","90","Select","Select",""],["","65862019105","CYCLOBENZAPR","10MG","30","Select","Select",""],["","11822003960","RA","100MG","4","Select","Select",""],["","52268020101","SUTAB","","24","Select","Select",""],["","11822333000","MAG","LEMON","296","Select","Select",""],["","55566410001","EUFLEXXA","10MG\/ML","12","Select","Select",""],["","80777027398","MODERNA","COVID-19","0","Select","Select",""],["","80777027398","MODERNA ","INJ COVID-19","0","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","",""],["No","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","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":""}]}]}