{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CLARENCE   W HAMILTON","gend":0,"add":"13 WESTLAKE CT","city":"WILLIAMSBURG","state":"VA","zip":"23185-9998","dob":"1959-10-28","age":"","mstatus":"","insh":"900036999*01","cliId":"6RX9JA0DW54","pno":"757\/232-2584","cno":"757\/232-2584","email":"","ename":"","eno":"","pphy":"THOMPSON, JAMES A DO","ppno":"757\/877-4221","pcpadd":"860 OMNI BLVD SUITE 110","pcpcity":"NEWPORT NEWS","pcpstate":"VA","pcpzip":23606,"pcpcounty":"","pcpid":157580,"pcpname":"PENINSULA INTERNAL AND GERIATRIC MEDICINE","plan":"OHP","program":"MEDICARE","lob":"MA-Non DSNP","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/886-1042","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R30.0","G60.9","I10.","I73.9","F33.9","I67.1","M79.10","I25.10","F17.200","R56.9","R63.4","R41.89","Z00.00","G57.51","G57.52","M79.671","M79.672","G64.","Z12.5"],"date":["2020-05-12","2020-09-28","2020-09-28","2020-09-28","2020-09-28","2020-09-28","2020-09-28","2020-09-28","2020-09-28","2020-09-28","2020-09-28","2020-09-28","2020-09-28","2020-04-16","2020-04-16","2020-04-16","2020-04-16","2020-04-16","2020-02-25"],"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":[["","68645049554","ATORVASTATIN ","80MG","90","Select","Select",""],["","00591060601","LABETALOL ","200MG","-180","Select","Select",""],["","55111019605","CLOPIDOGREL ","75MG","90","Select","Select",""],["","68645051654","AMLODIPINE ","10MG","90","Select","Select",""],["","64380073706","VITAMIN ","50000UNT","12","Select","Select",""],["","68645052154","SERTRALINE ","25MG","90","Select","Select",""],["","73575000909","PLIAGLIS ","7-7%","240","Select","Select",""],["","69499033060","CHLORZOXAZON ","250MG","-120","Select","Select",""],["","00378811745","DOXEPIN ","5%","225","Select","Select",""],["","29300011816","TOPIRAMATE ","200MG","180","Select","Select",""],["","66993087778","CALCIPOTRIEN ","0.01%","120","Select","Select",""],["","68462046447","HC ","0.10%","-225","Select","Select",""],["","68645055454","LISINOPRIL ","30MG","90","Select","Select",""],["","50228017705","GABAPENTIN ","600MG","270","Select","Select",""],["","47781030801","NITROFUR ","100MG","14","Select","Select",""],["","72205001390","PREGABALIN ","75MG","180","Select","Select",""],["","49281042050","FLUZONE ","2020-21","0","Select","Select",""],["","57237001760","DULOXETINE ","20MG","30","Select","Select",""],["","47335089413","","75MG","90","Select","Select",""],["","00591060601","LABETALOL","200MG","180","Select","Select",""],["","68645051654","AMLODIPINE","10MG","90","Select","Select",""],["","64380073706","VITAMIN","50000UNT","12","Select","Select",""],["","47335089413","CLOPIDOGREL","75MG","90","Select","Select",""],["","68645052154","SERTRALINE","25MG","90","Select","Select",""],["","69499033060","CHLORZOXAZON","250MG","-120","Select","Select",""],["","66993087778","CALCIPOTRIEN","0.01%","240","Select","Select",""],["","29300011816","TOPIRAMATE","200MG","180","Select","Select",""],["","68462046447","HC","0.10%","-225","Select","Select",""],["","68645055454","LISINOPRIL","30MG","90","Select","Select",""],["","73575000909","PLIAGLIS","7-7%","240","Select","Select",""],["","00378811745","DOXEPIN","5%","225","Select","Select",""],["","67877022310","GABAPENTIN","300MG","90","Select","Select",""],["","68645049554","ATORVASTATIN","80MG","90","Select","Select",""],["","49281042050","FLUZONE","2020-21","0","Select","Select",""],["","47781030801","NITROFUR","100MG","14","Select","Select",""],["","57237001760","DULOXETINE","20MG","30","Select","Select",""],["","72205001390","PREGABALIN","75MG","180","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":""}]}]}