{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JOHNNY   C DAY","gend":0,"add":"501 FAIRFIELD DR","city":"CHESAPEAKE","state":"VA","zip":"23322-9998","dob":"1954-09-04","age":"","mstatus":"","insh":"900037233*01","cliId":"9V61MA2TW32","pno":"757\/240-0453","cno":"757\/240-0453","email":"","ename":"","eno":"","pphy":"LIGHT, RYAN E MD","ppno":"757\/389-5370","pcpadd":"STE 100 1100 VOLVO PKWY","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":23320,"pcpcounty":"","pcpid":170690,"pcpname":"GREENBRIER FAMILY MEDICINE","plan":"OHP","program":"MEDICARE","lob":"MA-Non DSNP","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/389-5381","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I63.9","I48.0","C61.","Z68.24","R63.4","Z86.010","I48.91","I63.50","Z79.01","K21.9","D48.5","Z11.1","Z13.31","Z00.00","E78.2","Z86.73","N52.9","Z12.11","K44.9","K29.70","Z85.46","Z20.828","K62.7","K57.30","K64.8","R11.0","J02.9","I48.20","L57.0","L56.8","Z12.83","Z85.828","C44.311","Z51.11"],"date":["2020-01-31","2021-02-26","2021-03-10","2021-02-26","2020-09-21","2020-09-21","2020-06-03","2020-06-03","2021-10-21","2020-06-03","2021-04-13","2020-06-22","2021-02-24","2021-02-24","2021-02-26","2021-02-26","2020-03-09","2020-09-21","2020-09-21","2020-09-21","2020-05-06","2020-09-14","2020-09-21","2020-09-21","2020-09-21","2020-09-21","2021-05-19","2021-10-21","2021-06-03","2021-11-11","2021-11-11","2021-11-11","2021-09-23","2021-09-23"],"priorHcc":["","","","","","","","",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":[["","000005197102","PREVNAR ","","0","Select","Select",""],["","068382013201","TAMSULOSIN ","0.4MG","90","Select","Select",""],["","000002446234","CIALIS ","5MG","30","Select","Select",""],["","050458057930","XARELTO ","20MG","90","Select","Select",""],["","052268001201","SUPREP ","PREP KIT","354","Select","Select",""],["","065862056090","PANTOPRAZOLE ","40MG","90","Select","Select",""],["","049281012065","FLUZONE ","PF 20-21","1","Select","Select",""],["","000006483703","PNEUMOVAX ","25\/0.5","0","Select","Select",""],["","68382013201","","0.4MG","-90","Select","Select",""],["","00005197102","PREVNAR","","0","Select","Select",""],["","68382013201","TAMSULOSIN","0.4MG","90","Select","Select",""],["","00002446234","CIALIS","5MG","30","Select","Select",""],["","50458057930","XARELTO","20MG","90","Select","Select",""],["","52268001201","SUPREP","PREP KIT","-354","Select","Select",""],["","49281012065","FLUZONE","PF 20-21","1","Select","Select",""],["","00378668999","PANTOPRAZOLE","40MG","90","Select","Select",""],["","45802036862","IMIQUIMOD","5%","-12","Select","Select",""],["","33342032915","TRIAMCINOLON","0.10%","15","Select","Select",""],["","00006483703","PNEUMOVAX","25\/0.5","0","Select","Select",""],["","33342032915","TRIAMCINOLON ","CRE 0.001","15","Select","Select",""],["","45802036862","IMIQUIMOD ","CRE 0.05","12","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":""}]}]}