{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"RAY   E SPEIGHT","gend":0,"add":"7756 THE POINTS PL","city":"GLOUCESTER POINT","state":"VA","zip":"23062-9998","dob":"1937-02-23","age":"","mstatus":"","insh":"900042348*01","cliId":"8DM1AA5WU33","pno":"804\/815-0916","cno":"804\/815-0916","email":"","ename":"","eno":"","pphy":"STONE, ERIC B MD","ppno":"804\/642-6171","pcpadd":"2246 GEORGE WASHINGTON MEMORIAL HIG","pcpcity":"HAYES","pcpstate":"VA","pcpzip":23072,"pcpcounty":"","pcpid":118380,"pcpname":"Hayes Medical Center","plan":"OHP","program":"MEDICARE","lob":"MA-Non DSNP","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/642-5656","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M51.26","M51.27","M48.061","M48.07","M47.816","K59.00","I25.10","I10.","E78.5","M47.12","R53.81","R29.6","Z91.81","R31.9","S60.939A","C67.2","N40.1","Z90.79","E22.1","H81.10","I73.9","Z72.0","Z90.5","M48.062","R29.898","R53.1","R29.2","G95.9","C67.9","R39.14","I65.23","M54.42","I25.810","I65.22","Z85.51","I87.2","N32.0","I25.2","R04.0","H61.22","Z98.890","E78.49","Z95.5","F17.210","Z87.891","H90.3","R26.81","Z99.3","R27.9","M48.02","Z00.00","M51.36","M53.3","C67.5","N13.8","R35.1","D41.4","Z23.","Z20.822","N40.0","T81.31XD","Z79.82","Z79.02","R26.89","M54.2","M54.5","Z95.820","M54.16","R26.2","G25.3","M46.90","M50.01","M50.021","M50.022","F43.20"],"date":["2021-07-13","2021-07-13","2021-07-13","2021-07-13","2021-07-13","2021-08-24","2021-10-08","2021-10-08","2021-10-08","2021-10-08","2021-09-16","2021-08-26","2021-08-26","2021-09-05","2021-09-03","2021-09-16","2021-10-08","2021-09-10","2021-09-10","2021-09-10","2021-10-08","2021-09-10","2021-09-16","2021-10-08","2021-07-23","2021-07-23","2021-07-23","2021-07-30","2021-08-30","2021-10-08","2021-06-11","2021-07-12","2021-09-16","2021-10-08","2021-08-12","2021-10-08","2021-08-12","2021-10-08","2021-02-25","2021-05-05","2021-08-29","2021-08-29","2021-09-16","2021-04-16","2021-05-07","2021-04-28","2021-05-07","2021-04-28","2021-08-26","2021-10-08","2021-10-25","2021-06-02","2021-06-02","2021-09-16","2021-08-24","2021-08-24","2021-08-24","2021-09-16","2021-09-16","2021-08-30","2021-02-02","2021-05-07","2021-02-02","2021-07-11","2021-09-06","2021-09-06","2021-05-07","2021-06-23","2021-06-23","2021-06-23","2021-07-30","2021-07-30","2021-07-30","2021-07-30","2021-09-09"],"priorHcc":[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,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":[["","55111019690","","75MG","90","Select","Select",""],["","65162003310","APAP\/CODEINE","300-30MG","6","Select","Select",""],["","00093310953","AMOXICILLIN","500MG","-15","Select","Select",""],["","55111019690","CLOPIDOGREL","75MG","90","Select","Select",""],["","31722099601","HYDROCO\/APAP","5-325MG","-20","Select","Select",""],["","57237010099","METOPROL","25MG","90","Select","Select",""],["","60505009500","DOXAZOSIN","4MG","90","Select","Select",""],["","11822334910","RA","6.5% OT","15","Select","Select",""],["","00591352530","LIDOCAINE","5%","30","Select","Select",""],["","29300034301","BACLOFEN","10MG","60","Select","Select",""],["","68180063709","ATORVASTATIN","40MG","90","Select","Select",""],["","13668044201","CELECOXIB","200MG","60","Select","Select",""],["","55111019690","CLOPIDOGREL ","TAB 75MG","90","Select","Select",""],["","00093310953","AMOXICILLIN ","CAP 500MG","15","Select","Select",""],["","31722099601","HYDROCO\/APAP ","TAB 5-325MG","-20","Select","Select",""],["","60505258009","ATORVASTATIN ","TAB 40MG","90","Select","Select",""],["","65162003310","APAP\/CODEINE ","TAB 300-30MG","6","Select","Select",""],["","57237010099","METOPROL ","TAB 25MG","90","Select","Select",""],["","00591352530","LIDOCAINE ","PAD 0.05","30","Select","Select",""],["","60505009500","DOXAZOSIN ","TAB 4MG","90","Select","Select",""],["","29300034301","BACLOFEN ","TAB 10MG","60","Select","Select",""],["","13668044201","CELECOXIB ","CAP 200MG","60","Select","Select",""],["","11822334910","RA ","DRO 6.5% OT","15","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","",""],["No","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":""}]}]}