{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LLOYDEAN   D ABBOTT","gend":1,"add":"7320 GLENROIE AVE APT 3E","city":"NORFOLK","state":"VA","zip":"23505-9998","dob":"1945-01-28","age":"","mstatus":"","insh":"900035439*01","cliId":"7UF2W35CF07","pno":"757\/353-0309","cno":"757\/353-0309","email":"","ename":"","eno":"","pphy":"SHIPLEY, KATHERINE N PA","ppno":"757\/446-5955","pcpadd":"825 FAIRFAX AVE SUITE 118","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":"757\/446-5196","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M77.41","M77.42","Z12.11","R25.1","M20.21","M20.22","R19.5","R35.0","N30.90","R39.89","H25.813","H04.123","H16.143","H18.50","H43.812","Z00.00","Z01.810","Z01.812","Z20.828","I10.","E78.5","E03.9","R41.3","Z12.31","E11.65","G25.0","M17.10","Z13.31","L60.3","Z23.","R85.4","K57.30","Z00.01"],"date":["2020-03-04","2020-03-04","2020-10-26","2021-08-16","2020-02-05","2020-02-05","2020-10-28","2021-06-17","2021-06-17","2021-06-17","2021-03-09","2021-03-09","2021-03-09","2020-03-09","2021-03-09","2020-10-08","2020-10-26","2020-10-26","2020-10-26","2021-08-23","2021-08-16","2021-02-09","2020-11-04","2021-03-05","2021-08-23","2020-08-28","2020-10-08","2020-10-08","2020-02-19","2021-09-18","2020-10-28","2020-10-28","2021-02-16"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","",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":[["","49884093547","DICLOFENAC ","1%","-100","Select","Select",""],["","70377002911","ATORVASTATIN ","40MG","90","Select","Select",""],["","43547027611","DONEPEZIL ","10MG","90","Select","Select",""],["","68180051703","LISINOPRIL ","40MG","90","Select","Select",""],["","65862050220","AMOX\/K ","500-125","6","Select","Select",""],["","69238183207","LEVOTHYROXIN ","75MCG","90","Select","Select",""],["","53746054405","PRIMIDONE ","50MG","90","Select","Select",""],["","67877021901","CEPHALEXIN ","500MG","30","Select","Select",""],["","69367016304","PHENAZOPYRID ","200MG","9","Select","Select",""],["","70377002911","","40MG","90","Select","Select",""],["","70377002911","ATORVASTATIN","40MG","90","Select","Select",""],["","49884093547","DICLOFENAC","1%","-100","Select","Select",""],["","68180051703","LISINOPRIL","40MG","90","Select","Select",""],["","43547027611","DONEPEZIL","10MG","90","Select","Select",""],["","65862050220","AMOX\/K","500-125","6","Select","Select",""],["","69238183207","LEVOTHYROXIN","75MCG","90","Select","Select",""],["","53746054405","PRIMIDONE","50MG","90","Select","Select",""],["","69367016304","PHENAZOPYRID","200MG","9","Select","Select",""],["","67877021901","CEPHALEXIN","500MG","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":[[["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["No","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":""}]}]}