{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DOUGLAS   E OUTLAW JR","gend":0,"add":"3805 S CAPE HENRY AVE","city":"NORFOLK","state":"VA","zip":"23502-9998","dob":"1955-04-09","age":"","mstatus":"","insh":"900039457*01","cliId":"3C81N37XH13","pno":"757\/983-0892","cno":"757\/983-0892","email":"","ename":"","eno":"","pphy":"PHYSICIAN, MEDICARE PCP MD","ppno":"","pcpadd":"4417 CORPORATION LANE","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23462,"pcpcounty":"","pcpid":"800MR","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":["R73.09","Z74.3","E11.9","N39.0","K56.7","T83.9XXA","N30.00","I73.89","N30.90","T83.511A","E11.00","G92.","E11.40","I10.","F03.90","E78.5","E11.65","I69.349","Z74.01","Z79.899","Z79.4","Z79.02","R73.9","G82.21","K59.00","A41.9","R65.20","N30.01","N17.9","R77.8","G93.41","I63.89","G82.20","F03.91","B19.20","K59.09","R32.","R29.810","Z86.73","R53.1","I63.9","E16.2","B96.5","R78.81","Z87.440","N31.9","R41.82","B96.29","Z16.12","Z20.822","I63.30","N28.9","D72.829","R79.89","T83.198A","N18.9","R91.8","R05.","L02.211","N13.30","U07.1","R07.9","H53.8","T83.518A","A41.52","Z98.1","Z87.891","E66.9","L89.152","L89.322","L89.312","Z68.28","Z23.","R42.","D84.9","N12.","B96.20","D64.9","E11.22","N18.30","K21.9","I12.9","I51.7","I77.810","G93.40","T85.511A","R41.0","T81.509A","N13.6","F41.9","F32.9","K52.9","Z96.0","R10.0","K80.20","Z86.16","L98.499","A41.51","Z68.31","Z86.61"],"date":["2020-09-15","2021-07-27","2021-02-12","2021-07-09","2021-03-19","2020-11-23","2021-02-04","2020-09-01","2020-09-01","2021-07-09","2020-09-01","2020-09-01","2020-09-17","2021-02-12","2020-09-01","2021-07-06","2021-02-01","2020-09-01","2021-07-06","2020-09-01","2020-09-01","2020-09-01","2020-09-08","2020-12-24","2021-06-01","2021-07-12","2020-08-12","2021-07-12","2021-07-12","2020-08-12","2021-02-01","2020-08-12","2021-07-06","2020-08-12","2021-02-01","2021-02-01","2020-08-12","2020-08-12","2020-08-12","2021-07-05","2020-09-08","2020-09-02","2020-09-23","2020-09-23","2021-07-06","2021-07-06","2021-01-05","2021-07-09","2021-07-09","2021-02-02","2020-08-13","2020-09-01","2020-09-01","2020-09-01","2020-11-23","2021-07-06","2021-02-01","2021-02-01","2021-02-04","2021-02-08","2021-02-12","2021-07-06","2020-09-08","2020-09-17","2020-09-17","2020-09-17","2020-09-17","2021-07-06","2021-07-27","2020-09-17","2020-09-17","2020-09-17","2020-09-17","2020-12-24","2020-12-29","2020-12-29","2021-02-01","2020-12-29","2021-07-06","2020-12-29","2021-07-06","2021-07-06","2020-08-14","2020-08-14","2020-12-29","2020-12-29","2021-02-01","2021-04-03","2021-02-01","2021-07-06","2021-07-06","2021-06-01","2021-02-03","2021-06-02","2021-06-02","2021-07-27","2021-07-27","2021-07-06","2021-07-06","2021-07-06"],"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":[["","00456430001","MONUROL ","GRANULES","-2","Select","Select",""],["","50228018105","GABAPENTIN ","400MG","90","Select","Select",""],["","00088222033","LANTUS ","100\/ML","-30","Select","Select",""],["","68645059090","CLOPIDOGREL ","75MG","30","Select","Select",""],["","16714049401","AMOX\/K ","500-125","6","Select","Select",""],["","45802065078","LORATADINE ","10MG","30","Select","Select",""],["","00002751001","HUMALOG ","100\/ML","-10","Select","Select",""],["","68382009505","CARVEDILOL ","25MG","60","Select","Select",""],["","65162047810","NITROFURANTN ","100MG","14","Select","Select",""],["","65162062711","TRAMADOL ","50MG","30","Select","Select",""],["","16714007204","BACLOFEN ","20MG","90","Select","Select",""],["","057896044305","BISACODYL ","10MG","5","Select","Select",""],["","00456430001","","GRANULES","2","Select","Select",""],["","00456430001","MONUROL","GRANULES","2","Select","Select",""],["","65162062711","TRAMADOL","50MG","30","Select","Select",""],["","68382009505","CARVEDILOL","25MG","60","Select","Select",""],["","45802065078","LORATADINE","10MG","30","Select","Select",""],["","50228018105","GABAPENTIN","400MG","90","Select","Select",""],["","00088222033","LANTUS","100\/ML","30","Select","Select",""],["","00002751001","HUMALOG","100\/ML","-10","Select","Select",""],["","16714043901","NITROFURANTN","100MG","-14","Select","Select",""],["","16714049401","AMOX\/K","500-125","6","Select","Select",""],["","00603240728","BACLOFEN","20MG","90","Select","Select",""],["","57896044305","BISACODYL","10MG","5","Select","Select",""],["","68645059090","CLOPIDOGREL","75MG","30","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":""}]}]}