{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"NORMAN   L GAULT","gend":0,"add":"10630 SMITHS NECK ROAD","city":"CARROLLTON","state":"VA","zip":"23314-9998","dob":"1943-11-18","age":"","mstatus":"","insh":"900036579*01","cliId":"6X43VH5NX71","pno":"757\/615-4280","cno":"757\/615-4280","email":"","ename":"","eno":"","pphy":"POPE, THOMAS C MD","ppno":"757\/357-3331","pcpadd":"201 GUMWOOD DR","pcpcity":"SMITHFIELD","pcpstate":"VA","pcpzip":23430,"pcpcounty":"","pcpid":131791,"pcpname":"","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":["I48.91","I10.","E78.00","Z95.1","E11.59","R73.09","Z79.01","R97.20","H25.813","H25.811","H25.812","L57.0","L82.1","L81.7","Z71.9","D72.89","C91.10","Z00.00","Z68.35","Z13.89","Z23.","V49.49XA","I82.492","K75.4","Z68.36","H53.40","H53.462","H53.433","H01.00A","H01.00B","Z96.1","H26.493","Z01.810","R74.8","Z68.34","Z86.010","Z12.11"],"date":["2021-07-13","2021-07-13","2021-07-13","2020-01-15","2021-07-13","2020-06-30","2021-07-08","2021-07-08","2020-07-23","2020-08-21","2020-08-06","2020-10-08","2020-10-08","2020-10-08","2020-10-08","2021-07-12","2021-07-12","2021-07-13","2021-07-13","2021-07-13","2020-10-02","2020-07-09","2021-07-12","2021-07-13","2021-01-05","2020-11-17","2020-11-17","2020-11-17","2020-11-17","2020-11-17","2020-11-17","2020-11-17","2020-07-23","2021-07-15","2021-07-15","2021-07-15","2021-07-13"],"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":[["","68462040601","INDOMETHACIN ","25MG","270","Select","Select",""],["","60505258008","ATORVASTATIN ","40MG","90","Select","Select",""],["","69315011610","FUROSEMIDE ","20MG","90","Select","Select",""],["","30698006701","LASIX ","20MG","90","Select","Select",""],["","53489015610","ALLOPURINOL ","100MG","90","Select","Select",""],["","00378003210","METOPROL ","50MG","90","Select","Select",""],["","68180098003","LISINOPRIL ","10MG","90","Select","Select",""],["","62559051101","INDAPAMIDE ","2.5MG","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":[[["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":""}]}]}