{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LARIN   M ANDERS","gend":1,"add":"725 WATCH ISLAND REACH","city":"CHESAPEAKE","state":"VA","zip":"23320-9998","dob":"1970-05-12","age":"","mstatus":"","insh":"900046726*01","cliId":"3H09RG0DG44","pno":"757\/288-7751","cno":"757\/288-7751","email":"","ename":"","eno":"","pphy":"GAGLIONE, MARGARET M MD","ppno":"757\/644-6819","pcpadd":"1405 KEMPSVILLE ROAD","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":23320,"pcpcounty":"","pcpid":178852,"pcpname":"COASTAL INTERNAL MEDICINE AND TIDEWATER BARIATRICS","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"TIDEWATER","aligned":"Y","ano":"757\/549-2343","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/644-6816","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["D17.79","N32.89","R93.89","D17.5","E03.9","D72.818","G47.33","Q90.9","F32.9","Z85.820","M81.8","R22.9","E55.9","R82.90","L60.8","B35.1","M79.674","M79.675","R46.89","Z00.01","Z71.89","F63.3"],"date":["2021-03-02","2021-03-02","2021-03-02","2021-03-02","2021-10-19","2021-10-19","2021-10-19","2021-10-19","2021-10-19","2021-10-19","2021-10-19","2021-03-22","2021-08-17","2021-03-15","2021-10-28","2021-10-28","2021-10-28","2021-10-28","2021-10-19","2021-10-19","2021-08-24","2021-10-19"],"priorHcc":["","","","",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":[["","456046101","ARMOUR THYRO","TAB 120MG","90","Select","Select",""],["","13668001005","CITALOPRAM","TAB 20MG","90","Select","Select",""],["","63459022530","NUVIGIL","TAB 250MG","30","Select","Select",""],["","378180310","LEVOTHYROXIN","TAB 50MCG","102","Select","Select",""],["","93310905","AMOXICILLIN","CAP 500MG","21","Select","Select",""],["","69452015120","VITAMIN D","CAP 50000UNT","12","Select","Select",""],["","65862060230","MODAFINIL","TAB 200MG","30","Select","Select",""],["","378180310","LEVOTHYROXINE SODIUM ","","135","Select","Select",""],["","69452015120","VITAMIN D ","","12","Select","Select",""],["","63459022530","NUVIGIL ","","30","Select","Select",""],["","65862060230","MODAFINIL ","","30","Select","Select",""],["","456046101","ARMOUR THYROID","","90","Select","Select",""],["","13668001005","CITALOPRAM HYDROBROMIDE","","90","Select","Select",""],["","00378180310","LEVOTHYROXINE SODIUM","","135","Select","Select",""],["","50111056001","TRAZODONE HYDROCHLORIDE","50MG","15","Select","Select",""],["","65862096701","ESZOPICLONE","1MG","30","Select","Select",""],["","69452015120","VITAMIN D                                                             ","CAP 50000UNT","12","Select","Select",""],["","13668001005","CITALOPRAM HYDROBROMIDE                                               ","TAB 20MG","90","Select","Select",""],["","00093310905","AMOXICILLIN                                                           ","CAP 500MG","21","Select","Select",""],["","00378180310","LEVOTHYROXINE SODIUM                                                  ","TAB 50MCG","135","Select","Select",""],["","00456046101","ARMOUR THYROID                                                        ","TAB 120MG","90","Select","Select",""],["","63459022530","NUVIGIL                                                               ","TAB 250MG","90","Select","Select",""],["","65862060230","MODAFINIL                                                             ","TAB 200MG","30","Select","Select",""],["","50111056001","TRAZODONE HYDROCHLORIDE                                               ","TAB 50MG","15","Select","Select",""],["","65862096701","ESZOPICLONE                                                           ","TAB 1MG","30","Select","Select",""],["","49281042150","FLUZONE QUADRIVALENT 2021-2022                                        ","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":[[["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":""}]}]}