{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MARK   A MLECZAK","gend":0,"add":"4625 PAUL REVERE RD","city":"VIRGINIA BEACH","state":"VA","zip":"23455-9998","dob":"1953-01-22","age":"","mstatus":"","insh":"900035954*01","cliId":"1AU2R06QD26","pno":"646\/257-0793","cno":"646\/257-0793","email":"","ename":"","eno":"","pphy":"RYAL, JENNIFER L MD","ppno":"757\/446-8920","pcpadd":"SUITE 445 825 FAIRFAX AVE","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":"","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":["N39.3","C61.","R73.03","I10.","E78.5","G47.00","Z87.891","Z23.","R82.2","Z86.010","N39.498","S61.012A","M19.072","M79.671","M79.672","Z01.818","Z01.812","Z11.59","Z12.11","H25.13","D31.31","R35.0","Z01.810","N40.1","N39.0","N36.2","R35.1","N13.8","R31.9","Z20.822","N28.89","Z91.81","Z13.9","Z13.31","R73.9","M50.90","Z85.46","K63.5","N48.83","N28.1","D12.2","D12.3","K63.89","Z00.00","E66.9"],"date":["2021-04-01","2021-06-07","2021-09-01","2021-09-01","2021-09-01","2021-09-01","2021-09-01","2020-11-06","2021-01-11","2021-09-01","2021-01-11","2020-12-01","2021-04-20","2021-04-06","2021-04-06","2020-07-14","2021-01-13","2020-07-14","2021-05-23","2020-12-15","2020-12-15","2021-01-13","2020-02-18","2021-02-04","2021-04-01","2021-04-01","2021-02-04","2021-02-04","2021-01-13","2021-01-13","2021-01-25","2021-03-04","2021-09-01","2021-09-01","2021-09-01","2021-03-23","2020-07-17","2021-03-16","2021-04-01","2020-12-28","2021-08-11","2021-08-11","2021-08-11","2021-10-04","2021-09-01"],"priorHcc":["","",null,null,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":[["","049483062309","METFORMIN ","500MG ER","360","Select","Select",""],["","016729009016","FINASTERIDE ","5MG","90","Select","Select",""],["","065862020399","LOSARTAN ","100MG","90","Select","Select",""],["","060505258008","ATORVASTATIN ","40MG","90","Select","Select",""],["","067877032005","IBUPROFEN ","600MG","180","Select","Select",""],["","042858010250","OXYCOD\/APAP ","5-325MG","16","Select","Select",""],["","069097012815","AMLODIPINE ","10MG","90","Select","Select",""],["","070461012003","FLUAD ","0.5ML","0","Select","Select",""],["","013668000710","ZOLPIDEM ","5MG","30","Select","Select",""],["","000904645780","DOK ","100MG","14","Select","Select",""],["","000574014560","TROSPIUM ","20MG","180","Select","Select",""],["","061442010310","DICLOFENAC ","75MG DR","120","Select","Select",""],["","065649040001","PLENVU ","","3","Select","Select",""],["","052268020101","SUTAB ","","24","Select","Select",""],["","072647033104","METHYLPRED ","4MG","21","Select","Select",""],["","000469260290","MYRBETRIQ ","50MG","90","Select","Select",""],["","49483062309","","500MG ER","360","Select","Select",""],["","49483062309","METFORMIN","500MG ER","360","Select","Select",""],["","69097012815","AMLODIPINE","10MG","90","Select","Select",""],["","16729009016","FINASTERIDE","5MG","90","Select","Select",""],["","65862020399","LOSARTAN","100MG","90","Select","Select",""],["","60505258008","ATORVASTATIN","40MG","90","Select","Select",""],["","00904645780","DOK","100MG","14","Select","Select",""],["","67877032005","IBUPROFEN","600MG","180","Select","Select",""],["","00469260290","MYRBETRIQ","50MG","90","Select","Select",""],["","13668000710","ZOLPIDEM","5MG","30","Select","Select",""],["","00574014560","TROSPIUM","20MG","180","Select","Select",""],["","42858010201","OXYCOD\/APAP","5-325MG","1","Select","Select",""],["","65649040001","PLENVU","","3","Select","Select",""],["","52268020101","SUTAB","","24","Select","Select",""],["","70461012103","FLUAD","2021-22","0","Select","Select",""],["","61442010310","DICLOFENAC","75MG DR","120","Select","Select",""],["","72647033104","METHYLPRED","4MG","21","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":""}]}]}