{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JOHNNIE   A COX","gend":0,"add":"928 ARM CIR APT 202","city":"NORFOLK","state":"VA","zip":"23505-9998","dob":"1951-07-18","age":"","mstatus":"","insh":"900035022*01","cliId":"5G31YK6RQ14","pno":"757\/961-0547","cno":"757\/961-0547","email":"","ename":"","eno":"","pphy":"CHAKAN, MATTHEW C MD","ppno":"757\/446-8920","pcpadd":"825 FAIRFAX AVE SUITE 445","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23507,"pcpcounty":"","pcpid":100073,"pcpname":"EVMS Internal Medicine","plan":"OHP","program":"MEDICARE","lob":"MA-Non DSNP","region":"TIDEWATER","aligned":"","ano":"757\/288-5396","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/446-5242","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J02.9","H25.13","H40.053","H11.151","H52.4","L91.8","I10.","Z87.891","Z13.9","Z13.31","M25.561","M17.11","E66.01","E78.5","L85.8","R73.09","E88.81","M67.40","B07.9","R21.","Z00.00","G47.33","J02.0","Z12.11","D50.9"],"date":["2020-02-21","2021-11-02","2021-08-24","2021-11-02","2021-03-02","2020-11-17","2021-05-05","2021-05-05","2021-05-05","2021-05-05","2021-09-30","2021-05-05","2020-11-11","2021-05-05","2020-07-08","2021-05-05","2020-11-11","2020-02-04","2020-08-10","2020-08-10","2021-05-05","2020-11-11","2020-02-21","2021-05-23","2021-05-05"],"priorHcc":["",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":[["","13668025330","OLM ","40-25MG","30","Select","Select",""],["","50742061710","METOPROL ","100MG ER","90","Select","Select",""],["","65862001501","AMOXICILLIN ","875MG","20","Select","Select",""],["","68682010910","NIFEDIPINE ","60MG ER","30","Select","Select",""],["","41167005706","ASPERCREME ","10%","177","Select","Select",""],["","16571020210","DICLOFENAC ","50MG DR","30","Select","Select",""],["","00054327099","FLUTICASONE ","50MCG","-16","Select","Select",""],["","70377002911","ATORVASTATIN ","40MG","-30","Select","Select",""],["","76385011150","CARVEDILOL ","6.25MG","180","Select","Select",""],["","68682010910","","60MG ER","30","Select","Select",""],["","68682010910","NIFEDIPINE","60MG ER","30","Select","Select",""],["","50742061710","METOPROL","100MG ER","30","Select","Select",""],["","13668025330","OLM","40-25MG","30","Select","Select",""],["","65862001501","AMOXICILLIN","875MG","20","Select","Select",""],["","41167005706","ASPERCREME","10%","177","Select","Select",""],["","00054327099","FLUTICASONE","50MCG","16","Select","Select",""],["","16571020210","DICLOFENAC","50MG DR","30","Select","Select",""],["","70377002911","ATORVASTATIN","40MG","-30","Select","Select",""],["","76385011150","CARVEDILOL","6.25MG","180","Select","Select",""],["","24689079201","TERAZOSIN ","CAP 1MG","30","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":""}]}]}