{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CHESTER   C HUNTER JR","gend":0,"add":"1244 BRAHMS DR","city":"VIRGINIA BEACH","state":"VA","zip":"23454-9998","dob":"1953-01-13","age":"","mstatus":"","insh":"900034773*01","cliId":"4K04XA5EA99","pno":"757\/403-3358","cno":"757\/403-3358","email":"","ename":"","eno":"","pphy":"KAMEL, NANCY MD","ppno":"757\/821-2088","pcpadd":"1232 PERIMETER PKWY SUITE 101","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23454,"pcpcounty":"","pcpid":188240,"pcpname":"TPMG CORPORATE LANDING INTERNAL FAM MEDICINE","plan":"OHP","program":"MEDICARE","lob":"MA-Non DSNP","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/821-2081","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["H93.13","H90.11","S22.32XA","M54.9","M25.561","R73.03","Z00.00","I10.","E78.2","Z12.5","R73.01","F33.1","Z68.25","D50.9","D51.8","E78.5","E03.9","Z23.","F51.01","G25.81","S60.511A","K21.9","E55.9","S22.32XD","M17.11","N40.1","R35.1","Z12.11","K57.30","K62.1","R42.","R07.9","Z20.828","U07.1","I78.1","D22.9","L82.1","Z71.9"],"date":["2020-02-24","2020-02-24","2021-02-22","2021-02-22","2021-07-13","2021-09-28","2021-06-07","2021-09-28","2021-09-28","2020-01-07","2020-02-03","2021-01-18","2021-03-04","2020-08-11","2020-08-11","2021-01-18","2021-01-18","2020-10-19","2020-02-03","2020-02-03","2020-02-03","2020-02-03","2021-01-18","2021-03-04","2021-07-13","2020-09-14","2020-09-14","2020-01-22","2020-01-22","2020-01-22","2021-08-03","2021-08-03","2021-10-14","2021-10-03","2021-10-11","2021-10-11","2021-10-11","2021-10-11"],"priorHcc":["","","","","",null,"",null,null,"","","","","","","","","","","","","","","","","","","","","","","",null,null,null,null,null,null]}},{"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":[["","62175011843","OMEPRAZOLE ","20MG","180","Select","Select",""],["","55111012205","ATORVASTATIN ","20MG","90","Select","Select",""],["","00228202996","ALPRAZOLAM ","0.5MG","180","Select","Select",""],["","68180072003","AMLODIPINE ","5MG","90","Select","Select",""],["","68462019005","NAPROXEN ","500MG","180","Select","Select",""],["","00378623201","CITALOPRAM ","20MG","90","Select","Select",""],["","00002446230","CIALIS ","5MG","90","Select","Select",""],["","16571020150","DICLOFENAC ","75MG DR","30","Select","Select",""],["","00591352530","LIDOCAINE ","5%","10","Select","Select",""],["","68180098103","LISINOPRIL ","20MG","90","Select","Select",""],["","52817033200","CYCLOBENZAPR ","10MG","-30","Select","Select",""],["","59746000103","METHYLPRED ","4MG","21","Select","Select",""],["","59651000205","","20MG","60","Select","Select",""],["","68180072003","AMLODIPINE","5MG","90","Select","Select",""],["","59651000205","OMEPRAZOLE","20MG","60","Select","Select",""],["","00378395105","ATORVASTATIN","20MG","-90","Select","Select",""],["","00228202996","ALPRAZOLAM","0.5MG","180","Select","Select",""],["","68462019005","NAPROXEN","500MG","180","Select","Select",""],["","00378623201","CITALOPRAM","20MG","90","Select","Select",""],["","68382091634","METHYLPRED","4MG","21","Select","Select",""],["","00591352530","LIDOCAINE","5%","10","Select","Select",""],["","68180098103","LISINOPRIL","20MG","-90","Select","Select",""],["","16571020150","DICLOFENAC","75MG DR","30","Select","Select",""],["","52817033200","CYCLOBENZAPR","10MG","-30","Select","Select",""],["","00002446230","CIALIS","5MG","90","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":[[["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","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":""}]}]}