{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"EDWARD   L CHERRY","gend":0,"add":"214 GREENBRIER AVE","city":"NORFOLK","state":"VA","zip":"23505-9998","dob":"1963-06-18","age":"","mstatus":"","insh":"900039153*01","cliId":"1FP9J00VH46","pno":"757\/353-1510","cno":"757\/353-1510","email":"","ename":"","eno":"","pphy":"BONEY, ARON R MD","ppno":"757\/278-2240","pcpadd":"155 KINGSLEY LANE SUITE 400","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23505,"pcpcounty":"","pcpid":142722,"pcpname":"DEPAUL MEDICAL ASSOCIATES","plan":"OHP","program":"MEDICARE","lob":"MA-Non DSNP","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/489-6469","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I96.","E11.40","F17.210","I74.9","I70.202","I73.9","I70.212","F17.200","E11.51","M77.41","M77.42","B35.1","E11.9","I70.203","M79.672","R68.89","E11.65","E11.42","Z12.11"],"date":["2020-11-07","2021-04-10","2020-10-10","2020-06-25","2020-07-11","2021-03-23","2021-03-23","2021-03-23","2021-03-23","2020-11-07","2020-11-07","2021-09-11","2020-10-09","2020-06-25","2020-04-24","2021-06-17","2021-06-17","2021-07-24","2021-07-06"],"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":[["","49884005501","IMIPRAM ","25MG","90","Select","Select",""],["","16571040250","CETIRIZINE ","10MG","30","Select","Select",""],["","00093206506","CILOSTAZOL ","50MG","60","Select","Select",""],["","68645059090","CLOPIDOGREL ","75MG","30","Select","Select",""],["","00456120130","LINZESS ","145MCG","30","Select","Select",""],["","45802008801","ALBUTEROL ","HFA","8","Select","Select",""],["","43598075205","BUPROPION ","150MG SR","60","Select","Select",""],["","50742061510","METOPROL ","25MG ER","90","Select","Select",""],["","68382032010","POT  CHLORIDE","10MEQ ER","90","Select","Select",""],["","67877022310","GABAPENTIN ","300MG","-180","Select","Select",""],["","31722071390","PANTOPRAZOLE ","40MG","90","Select","Select",""],["","00254200801","COLCHICINE ","0.6MG","30","Select","Select",""],["","68645056854","ATORVASTATIN ","40MG","90","Select","Select",""],["","68645051054","HYDROCHLOROT ","25MG","90","Select","Select",""],["","31722070190","LOSARTAN ","50MG","180","Select","Select",""],["","68645058459","METFORMIN ","1000MG","180","Select","Select",""],["","70461032003","FLUCLVX ","2020-21","0","Select","Select",""],["","45802013811","CICLOPIROX ","0.77%","30","Select","Select",""],["","49035045875","ALLERGY ","10MG","90","Select","Select",""],["","65702071110","ACCU-CHEK ","GUIDE","200","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","81131031271","VITAMIN ","5000UNIT","4","Select","Select",""],["","50111056001","TRAZODONE ","50MG","30","Select","Select",""],["","10702000709","CYCLOBENZAPR ","10MG","90","Select","Select",""],["","45802086803","POLYETH ","3350 NF","715","Select","Select",""],["","00536589488","NICOTINE ","7MG\/24HR","30","Select","Select",""],["","000781261305","AMOXICILLIN ","500MG","21","Select","Select",""],["","068645056354","IBUPROFEN ","800MG","30","Select","Select",""],["","00093206506","","50MG","60","Select","Select",""],["","16571040250","CETIRIZINE","10MG","30","Select","Select",""],["","00093206506","CILOSTAZOL","50MG","60","Select","Select",""],["","43598075205","BUPROPION","150MG SR","60","Select","Select",""],["","50742061510","METOPROL","25MG ER","90","Select","Select",""],["","67877022310","GABAPENTIN","300MG","-180","Select","Select",""],["","00456120130","LINZESS","145MCG","90","Select","Select",""],["","68645059090","CLOPIDOGREL","75MG","30","Select","Select",""],["","00254200801","COLCHICINE","0.6MG","30","Select","Select",""],["","45802008801","ALBUTEROL","HFA","8","Select","Select",""],["","31722071390","PANTOPRAZOLE","40MG","90","Select","Select",""],["","31722070190","LOSARTAN","50MG","180","Select","Select",""],["","49884005501","IMIPRAM","25MG","-90","Select","Select",""],["","68645058459","METFORMIN","1000MG","180","Select","Select",""],["","00093505898","ATORVASTATIN","40MG","90","Select","Select",""],["","68645051054","HYDROCHLOROT","25MG","90","Select","Select",""],["","68382032010","POT CHLORIDE","10MEQ ER","90","Select","Select",""],["","70461032003","FLUCLVX","2020-21","0","Select","Select",""],["","49035045875","ALLERGY","10MG","90","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","45802013811","CICLOPIROX","0.77%","30","Select","Select",""],["","65702071110","ACCU-CHEK","GUIDE","-200","Select","Select",""],["","10702000709","CYCLOBENZAPR","10MG","90","Select","Select",""],["","00781261305","AMOXICILLIN","500MG","21","Select","Select",""],["","81131031271","VITAMIN","5000UNIT","4","Select","Select",""],["","45802086803","POLYETH","3350 NF","715","Select","Select",""],["","50111056001","TRAZODONE","50MG","30","Select","Select",""],["","00536589488","NICOTINE","7MG\/24HR","30","Select","Select",""],["","68645056354","IBUPROFEN","800MG","30","Select","Select",""],["","49281042150","FLUZONE","2021-22","0","Select","Select",""],["","49281042150","FLUZONE ","INJ 2021-22","0","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","",""],["Yes","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":""}]}]}