{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"WILLIE   R SYKES JR","gend":0,"add":"9447 CENTRAL HILL ROAD","city":"WINDSOR","state":"VA","zip":"23487-9998","dob":"1950-11-19","age":"","mstatus":"","insh":"900043496*01","cliId":"2GC4EK8TG05","pno":"434\/637-0305","cno":"434\/637-0305","email":"","ename":"","eno":"","pphy":"PHYSICIAN, MR PRIMARY CARE MD","ppno":"","pcpadd":"4417 CORPORATION LANE","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23462,"pcpcounty":"","pcpid":"799MR","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":["K31.89","D64.9","D50.8","D70.8","K29.70","R10.13","K21.9","E78.5","I25.10","I48.0","I10.","M48.062","M47.26","Z98.1","Z01.812","Z20.822","Z01.818","Z47.89","E11.9","Z79.01","Z79.02","Z79.84","Z91.81","N40.1","E11.65","N30.90","M53.2X6","I48.91","Z86.010","D12.2","D12.5","Z68.26","K59.09","Z80.0","I25.2","N18.30","E11.41","M54.5","D62.","I12.9","E11.22","R26.89","K63.5","H25.13","H25.013","H11.153","H04.123","E11.3312","E11.3291","E11.3392","E11.3293","H25.12","H25.11","Z98.890","E78.2"],"date":["2021-01-18","2021-06-25","2021-06-25","2021-06-25","2021-01-18","2021-01-18","2021-03-22","2021-04-02","2021-10-11","2021-04-02","2021-10-11","2021-08-25","2021-08-25","2021-08-25","2021-01-11","2021-02-27","2021-01-11","2021-03-22","2021-03-22","2021-03-22","2021-03-22","2021-08-05","2021-03-22","2021-05-12","2021-08-11","2021-05-12","2021-03-02","2021-10-11","2021-02-24","2021-02-20","2021-02-20","2021-06-25","2021-02-09","2021-02-09","2021-02-09","2021-03-02","2021-02-09","2021-07-02","2021-03-02","2021-03-02","2021-03-02","2021-03-05","2021-02-20","2021-08-05","2021-08-05","2021-08-05","2021-08-05","2021-08-05","2021-08-05","2021-08-05","2021-07-07","2021-09-07","2021-08-31","2021-08-25","2021-10-11"],"priorHcc":["","","","","","","","",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":[["","053885024510","ONETOUCH ","ULTRA","300","Select","Select",""],["","060505008000","SOTALOL ","80MG","90","Select","Select",""],["","013668010401","ISOSORB ","30MG ER","90","Select","Select",""],["","000781223410","OMEPRAZOLE ","40MG","-90","Select","Select",""],["","055111019605","CLOPIDOGREL ","75MG","-90","Select","Select",""],["","000006057762","JANUMET ","50-1000","180","Select","Select",""],["","000002143380","TRULICITY ","0.75\/0.5","-6","Select","Select",""],["","065862059805","TAMSULOSIN ","0.4MG","90","Select","Select",""],["","068180021709","LOSARTAN\/HCT ","100-25","90","Select","Select",""],["","052817033200","CYCLOBENZAPR ","10MG","60","Select","Select",""],["","060505258008","ATORVASTATIN ","40MG","90","Select","Select",""],["","000406051201","OXYCOD\/APAP ","5-325MG","42","Select","Select",""],["","000904404073","ASPIRIN ","81MG","30","Select","Select",""],["","027241014401","SILODOSIN ","4MG","-30","Select","Select",""],["","055628910704","ULTRACIN ","5%","120","Select","Select",""],["","000003089321","ELIQUIS ","2.5MG","60","Select","Select",""],["","013811071910","NITROFURANTN ","100MG","20","Select","Select",""],["","69315030805","CIPROFLOXACN ","0.3% OP","5","Select","Select",""],["","61314063710","PREDNISOLONE ","1% OP","10","Select","Select",""],["","60505008000","","80MG","90","Select","Select",""],["","60505008000","SOTALOL","80MG","90","Select","Select",""],["","53885024510","ONETOUCH","ULTRA","-300","Select","Select",""],["","55111015810","OMEPRAZOLE","20MG","30","Select","Select",""],["","55111019605","CLOPIDOGREL","75MG","-90","Select","Select",""],["","00006057762","JANUMET","50-1000","180","Select","Select",""],["","00002143380","TRULICITY","0.75\/0.5","-6","Select","Select",""],["","60505258008","ATORVASTATIN","40MG","90","Select","Select",""],["","52817033200","CYCLOBENZAPR","10MG","-60","Select","Select",""],["","00406051201","OXYCOD\/APAP","5-325MG","42","Select","Select",""],["","68180021709","LOSARTAN\/HCT","100-25","90","Select","Select",""],["","13668010401","ISOSORB","30MG ER","90","Select","Select",""],["","27241014401","SILODOSIN","4MG","30","Select","Select",""],["","55628910704","ULTRACIN","5%","120","Select","Select",""],["","00003089321","ELIQUIS","2.5MG","60","Select","Select",""],["","13811071910","NITROFURANTN","100MG","20","Select","Select",""],["","61314063710","PREDNISOLONE","1% OP","10","Select","Select",""],["","69315030805","CIPROFLOXACN","0.3% OP","-5","Select","Select",""],["","50458057990","XARELTO","20MG","30","Select","Select",""],["","00904404073","ASPIRIN","81MG","30","Select","Select",""],["","65862059805","TAMSULOSIN","0.4MG","90","Select","Select",""],["","50458057990","XARELTO ","TAB 20MG","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":""}]}]}