{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BRANDON ABERSOLD","gend":0,"add":"3511 FARRIER COVE","city":"SUFFOLK","state":"VA","zip":"23435-3210","dob":"1986-04-03","age":"","mstatus":"","insh":3217222,"cliId":"","pno":7577799562,"cno":7577799562,"email":"","ename":"","eno":"","pphy":"KAPUR, ANAND","ppno":7576735890,"pcpadd":"5818 Harbour View Blvd Ste 250, ","pcpcity":"Suffolk","pcpstate":"VA","pcpzip":234353317,"pcpcounty":"","pcpid":"","pcpname":"BON SECOURS GRASSFIELD MEDICAL","ano":7576815062,"add2":"                                                            ","add3":"","madd1":"3511 FARRIER COVE","madd2":"                                                            ","madd3":"","mcity":"SUFFOLK","mstate":"VA","mzip":"23435-3210","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"TIDEWATER","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K85.90","E78.2","E11.65","E78.1","K80.20","Z87.891","E11.9","E11.8","Z79.4","R73.9","R11.2","E13.10","E11.10","K86.1","K56.1","R00.0","E66.9","E78.00","Z91.19","Z79.84","Z68.35","I10","Z87.19","E88.81","R80.9","Z68.34","E55.9","E11.21","R10.13","R10.9","M54.9","R61","R10.84"],"date":["2019-03-28","2019-06-05","2021-05-12","2019-07-30","2019-03-28","2019-03-28","2021-05-12","2021-05-12","2021-05-12","2019-03-24","2019-03-24","2019-03-26","2019-03-24","2019-06-05","2019-03-24","2019-03-24","2019-03-24","2019-03-24","2019-03-24","2019-06-05","2019-03-24","2019-07-30","2019-07-30","2019-07-30","2019-07-30","2019-07-30","2019-06-05","2019-07-30","2019-03-22","2019-03-22","2019-03-22","2019-03-22","2019-03-22"],"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":[["","00088221905","LANTUS ","INJ 100\/ML","6","Select","Select",""],["","68180036109","FENOFIBRATE ","TAB 145MG","30","Select","Select",""],["","69097094705","ATORVASTATIN ","TAB 80MG","30","Select","Select",""],["","00597015330","JARDIANCE ","TAB 25MG","30","Select","Select",""],["","68180098101","LISINOPRIL ","TAB 20MG","30","Select","Select",""],["","16729000201","GLIMEPIRIDE ","TAB 2MG","60","Select","Select",""],["","62756014202","METFORMIN ","TAB 500MG ER","120","Select","Select",""],["","00169750111","NOVOLOG ","INJ 100\/ML","50","Select","Select",""],["","00193731221","CONTOUR ","TES NEXT","600","Select","Select",""],["","67877019805","AMLODIPINE ","TAB 5MG","30","Select","Select",""],["","00406012305","HYDROCO\/APAP ","TAB 5-325MG","18","Select","Select",""],["","08290320550","BD  PEN NEEDL","MIS 32GX5\/32","30","Select","Select",""],["","67877032105","IBUPROFEN ","TAB 800MG","15","Select","Select",""],["","00002771559","BASAGLAR ","INJ 100UNIT","3","Select","Select",""],["","73070010315","INSULIN ","INJ FLEXPEN","6","Select","Select",""],["","00116200116","CHLORHEX ","SOL 0.0012","473","Select","Select",""],["","60258015001","SF ","CRE 0.011","51","Select","Select",""],["","00093310953","AMOXICILLIN ","CAP 500MG","28","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","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Yes","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":""}]}]}