{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" REHPOTSIRHCPURHTRON T  ","gend":0,"add":"ERAWALED 5113J TPA EVA ","city":"NORFOLK","state":"VA","zip":"23504-9998","dob":"1973-01-14","age":"","mstatus":"","insh":"0917110*09","cliId":"","pno":"23\/7438966-4","cno":"347\/324-6698","email":"","ename":"","eno":"","pphy":"MANDELL JR, M STEPHEN MD","ppno":"804\/633-5840","pcpadd":"121 COURTHOUSE LN","pcpcity":"BOWLING GREEN","pcpstate":"VA","pcpzip":22427,"pcpcounty":"","pcpid":195552,"pcpname":"","plan":"OHP","program":"ACA","lob":"Individual","region":"TIDEWATER","aligned":"","ano":"347\/324-6698, ","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":["B20.","E78.2","I10.","F33.1","R53.82","B00.9","K64.4","E78.5","Z23.","R53.83","Z03.818","Z11.59","Z13.220","Z20.822","Z20.828","U07.1","F33.9","F41.8","R07.9","E11.9","Z21.","Z82.49","R07.2","R07.89"],"date":["2020-08-18","2020-08-18","2021-09-02","2020-08-18","2020-08-18","2020-08-18","2020-08-18","2020-01-03","2020-01-03","2020-08-18","2020-07-02","2020-07-02","2020-01-03","2021-01-10","2020-12-24","2020-12-24","2021-06-29","2021-06-29","2021-09-02","2021-09-02","2021-09-02","2021-09-02","2021-09-02","2021-09-02"],"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":[["","49702023113","TRIUMEQ ","","-30","Select","Select",""],["","68180072003","AMLODIPINE ","5MG","-30","Select","Select",""],["","31722058330","DULOXETINE ","60MG","30","Select","Select",""],["","55111012105","ATORVASTATIN ","10MG","30","Select","Select",""],["","00378427577","VALACYCLOVIR ","500MG","30","Select","Select",""],["","68180037603","LOSARTAN ","25MG","30","Select","Select",""],["","00713050324","ANUCORT-HC ","25MG","30","Select","Select",""],["","23155013525","DOXYCYC ","100MG","30","Select","Select",""],["","75834002012","VITAMIN ","50000UNT","4","Select","Select",""],["","49702023113","TRIUMEQ","","-30","Select","Select",""],["","68180072003","AMLODIPINE","5MG","30","Select","Select",""],["","31722058330","DULOXETINE","60MG","30","Select","Select",""],["","55111012105","ATORVASTATIN","10MG","30","Select","Select",""],["","31722070010","LOSARTAN","25MG","30","Select","Select",""],["","00713050324","ANUCORT-HC","25MG","30","Select","Select",""],["","00378427577","VALACYCLOVIR","500MG","30","Select","Select",""],["","75834002012","VITAMIN","50000UNT","4","Select","Select",""],["","23155013525","DOXYCYC","100MG","30","Select","Select",""],["","00115180301","HYDROXYZ","25MG","-60","Select","Select",""],["","59267100002","PFIZER","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":[[["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","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":""}]}]}