{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"RANDOLYN   J HALTERMAN","gend":1,"add":"2312 BAYS EDGE AVE","city":"VIRGINIA BEACH","state":"VA","zip":"23452-9998","dob":"1952-01-03","age":"","mstatus":"","insh":"900043659*01","cliId":"2K59A48WX12","pno":"757\/403-6337","cno":"757\/403-6337","email":"","ename":"","eno":"","pphy":"ZEV, ZAHAN MD","ppno":"757\/484-0500","pcpadd":"2994 CHURCHLAND BLVD","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":23321,"pcpcounty":"","pcpid":101382,"pcpname":"","plan":"OHP","program":"MEDICARE","lob":"MA-Non DSNP","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/686-2805","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K52.89","R19.7","R15.9","K76.0","H40.013","Z12.31","Z01.89","H25.13","L03.019","D48.5","Z23.","M15.0","F32.9","M51.86","I10."],"date":["2021-04-14","2021-06-02","2021-06-02","2021-04-02","2021-04-02","2021-07-01","2021-04-14","2021-04-02","2021-05-01","2021-08-17","2021-10-21","2021-10-21","2021-10-21","2021-10-21","2021-10-21"],"priorHcc":["","","","","","","","","","",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":[["","000065027515","AZOPT ","1% OP","15","Select","Select",""],["","051672400101","NORTRIPTYLIN ","10MG","-180","Select","Select",""],["","045963067696","METOPROLOL ","50MG ER","90","Select","Select",""],["","000781601485","BRINZOLAMIDE ","1%","-15","Select","Select",""],["","000527260143","METOPROL ","50MG ER","90","Select","Select",""],["","057237017401","VENLAFAXINE ","50MG","-180","Select","Select",""],["","000093314705","CEPHALEXIN ","500MG","20","Select","Select",""],["","045802012801","CLINDAMYCIN ","1%","60","Select","Select",""],["","000023320503","LUMIGAN ","0.01%","8","Select","Select",""],["","00065027515","","1% OP","-15","Select","Select",""],["","00065027515","AZOPT","1% OP","15","Select","Select",""],["","45963067611","METOPROLOL","50MG ER","90","Select","Select",""],["","68382002001","VENLAFAXINE","50MG","180","Select","Select",""],["","51672400101","NORTRIPTYLIN","10MG","-180","Select","Select",""],["","00781601485","BRINZOLAMIDE","1%","-15","Select","Select",""],["","00093314705","CEPHALEXIN","500MG","20","Select","Select",""],["","00168020360","CLINDAMYCIN","1%","-60","Select","Select",""],["","45963067611","METOPROL","50MG ER","90","Select","Select",""],["","00378427577","VALACYCLOVIR","500MG","60","Select","Select",""],["","00143992801","CIPROFLOXACN","500MG","14","Select","Select",""],["","00023320503","LUMIGAN","0.01%","8","Select","Select",""],["","00143992801","CIPROFLOXACN ","TAB 500MG","14","Select","Select",""],["","00378427577","VALACYCLOVIR ","TAB 500MG","60","Select","Select",""],["","52268001201","SUPREP ","SOL PREP KIT","354","Select","Select",""],["","00591079510","DICYCLOMINE ","TAB 20MG","360","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":""}]}]}