{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" W  NAESEDIRBCM","gend":0,"add":"ORC 5051TC YTRAM","city":"VIRGINIA BEACH","state":"VA","zip":"23464-9998","dob":"1963-02-22","age":"","mstatus":"","insh":"0814810*21","cliId":"","pno":"0875704422","cno":"","email":"","ename":"","eno":"","pphy":"MOLLENKOPF, WILLIAM MD","ppno":7573522030,"pcpadd":"1168 FIRST COLONIAL ROAD","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":"23454-9998","pcpcounty":"","pcpid":"","pcpname":"First Colonial Medical Associates","plan":"OHP","program":"ACA","lob":"Small Group","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":["N40.0","N52.9","R35.1","N40.1","N52.1","Z80.42","E10.65"],"date":["2021-01-26","2021-01-26","2023-03-21","2023-03-21","2023-03-21","2023-03-21","2023-05-08"],"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":[["","47781065490","LEVOTHYROXIN","TAB 112MCG","90","Select","Select",""],["","00002446234","CIALIS","TAB 5MG","90","Select","Select",""],["","47335095688","ALFUZOSIN","TAB 10MG ER","90","Select","Select",""],["","68645054154","FINASTERIDE","TAB 5MG","90","Select","Select",""],["","68180047903","SIMVASTATIN","20 MG","90","Select","Select",""],["","00002751001","HUMALOG","100\/ML","30","Select","Select",""],["","00193731221","CONTOUR","TES NEXT","100","Select","Select",""],["","65162035109","SILDENAFIL","TAB 20MG","90","Select","Select",""],["","49281041950","FLUZONE","INJ 2019-20","0","Select","Select",""],["","72305011230","EUTHYROX","TAB 112MCG","90","Select","Select",""],["","66733077301","INSULIN","INJ 100\/ML","70","Select","Select",""],["","00456133001","LEVOTHROID","TAB 112MCG","90","Select","Select",""],["","49281072010","FLUBLOK","INJ 2020-21","0","Select","Select",""],["","13668056630","TADALAFIL","5 MG","90","Select","Select",""],["","57237011490","ALFUZOSIN HCL ER","10 MG","30","Select","Select",""],["","16729045215","LEVOTHYROXINE SODIUM","112 MCG","90","Select","Select",""],["","08627005303","DEXCOM G","6 SENSOR","9","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":""}]}]}