{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"  ACCEBERTRAHERA L","gend":1,"add":"IFDNAS 9072DAOR RELDD","city":"VIRGINIA BEACH","state":"VA","zip":23456,"dob":"1964-02-25","age":"","mstatus":"","insh":"0062210*29","cliId":"","pno":"52\/3079926-4","cno":"","email":"","ename":"","eno":"","pphy":"Route,  barbara","ppno":"757\/821-2088","pcpadd":"5424 Discovery Park Blvd BLDB A STE 201","pcpcity":"WILLIAMSBURG","pcpstate":"VA","pcpzip":23456,"pcpcounty":"","pcpid":"","pcpname":"TPMG CORPORATE LANDING INTERNAL FAM MEDICINE","plan":"OHP","program":"ACA","lob":"Individual","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":["E03.9","E11.65","E55.9","E66.1","E78.5","Z20.828","Z12.11","I10.","F51.04","G47.30","G62.9","Z68.28","K21.0"],"date":["2020-01-27","2020-04-07","2020-01-27","2020-01-27","2020-01-27","2020-10-31","2021-05-23","2020-04-07","2020-04-07","2020-03-05","2020-04-07","2020-03-05","2020-04-07"],"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":[["","70010049105","METFORMIN","TAB 500MG ER","360","Select","Select",""],["","63304071890","DILTIAZEM","CAP 120MG ER","90","Select","Select",""],["","68382050010","OMEPRAZOLE","CAP 40MG","-90","Select","Select",""],["","16729000617","SIMVASTATIN","TAB 40MG","90","Select","Select",""],["","29300012810","HYDROCHLOROT","TAB 25MG","-90","Select","Select",""],["","53885044801","ONETOUCH","KIT ULTRA 2","1","Select","Select",""],["","60505265301","TRAZODONE","TAB 50MG","-60","Select","Select",""],["","70710122600","AMITRIPTYLIN","TAB 25MG","30","Select","Select",""],["","65862020399","LOSARTAN","TAB 100MG","90","Select","Select",""],["","65862069790","VENLAFAXINE","CAP 150MG ER","90","Select","Select",""],["","69452015120","VITAMIN","CAP 50000UNT","12","Select","Select",""],["","65162010250","GABAPENTIN","CAP 300MG","90","Select","Select",""],["","00173068220","VENTOLIN","AER ","18","Select","Select",""],["","80777027310","MODERNA","INJ COVID-19","0","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","8","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":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"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":""}]}]}