{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SAMUEL   L OWENS","gend":0,"add":"3302 LYONS AVE","city":"NORFOLK","state":"VA","zip":"23509-9998","dob":"1952-05-26","age":"","mstatus":"","insh":"900033556*01","cliId":"2PT2DJ5CX91","pno":"757\/779-3204","cno":"757\/779-3204","email":"","ename":"","eno":"","pphy":"NEWMAN, ROBERT J MD","ppno":"757\/446-5955","pcpadd":"SUITE 118 825 FAIRFAX AVE","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23507,"pcpcounty":"","pcpid":100070,"pcpname":"EVMS Ghent Family Medicine","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":["C61.","E11.65","I10.","I87.2","M79.89","R00.2","N52.31","E11.42","H40.1131","H25.13","H52.4","Z12.11","R07.9","Z00.00","Z13.31","B19.20","Z90.49","R00.8","I49.3","R31.29","N39.3","Z85.46","N52.9","R31.0"],"date":["2021-08-23","2021-08-12","2020-12-02","2021-05-28","2021-05-28","2020-08-26","2021-08-23","2021-08-12","2021-07-23","2021-07-23","2020-06-10","2020-07-08","2020-08-14","2021-05-25","2020-08-12","2020-05-28","2020-05-28","2020-08-21","2020-08-21","2021-03-24","2021-08-23","2021-01-02","2021-08-23","2021-08-23"],"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":[["","59762033302","LATANOPROST ","0.01%","2","Select","Select",""],["","68382036211","TESTOSTERONE ","1.62%","75","Select","Select",""],["","65162010250","GABAPENTIN ","300MG","60","Select","Select",""],["","23155010405","METFORMIN ","1000MG","-30","Select","Select",""],["","68180072103","AMLODIPINE ","10MG","90","Select","Select",""],["","00378395205","ATORVASTATIN ","40MG","-90","Select","Select",""],["","53885004401","ONE ","VERIO FL","1","Select","Select",""],["","69097037402","TADALAFIL ","5MG","90","Select","Select",""],["","00363237001","LANCET ","THIN 30G","100","Select","Select",""],["","53885001110","ONETOUCH ","PLUS 30G","100","Select","Select",""],["","43386009019","GAVILYTE-G ","","4000","Select","Select",""],["","33332032001","AFLURIA ","2020-21","0","Select","Select",""],["","68180051202","LISINOPRIL ","2.5MG","90","Select","Select",""],["","49281012065","FLUZONE ","PF 20-21","1","Select","Select",""],["","00005197102","PREVNAR ","","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","",""],["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["Yes","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":""}]}]}