{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CHHAGANBHA   N PATEL","gend":0,"add":"2708 WEST MERCURY BLVD","city":"HAMPTON","state":"VA","zip":"23666-9998","dob":"1946-11-13","pno":"757\/288-1276","cno":"757\/288-1276","email":"","pphy":"NAGRAJ, HOSKOTE S MD","ppno":"","pcpadd":"12652 JEFFERSON AVE","pcpcity":"NEWPORT NEWS","pcpstate":"VA","pcpzip":23602,"pcpcounty":"","pcpid":118380,"pcpname":"Riverside Internal Medicine of Denbigh","insh":"900048733*01","cliId":"8F06X58GH74","plan":"OHP","program":"MEDICARE","lob":"MA-Non DSNP","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/234-4260","pcpnpi":""},{"a":{"indx":["","","","","","1","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M17.12","I12.9","E11.22","N18.31","Z79.84","Z96.659","M25.562","Z01.812","Z20.822","M25.462","Z96.652","K30.","Z23.","Z01.818","E78.5","N25.81","K21.9","G89.18"],"date":["2021-09-23","2021-11-03","2021-11-03","2021-11-03","2021-11-03","2021-11-03","2021-10-14","2021-09-20","2021-09-20","2021-09-23","2021-09-23","2021-10-14","2021-10-14","2021-09-08","2021-09-08","2021-09-08","2021-09-08","2021-09-23"],"priorHcc":[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":[["","69097015812","MELOXICAM","7.5MG","28","Select","Select",""],["","57896090110","ASPIRIN","325MG","42","Select","Select",""],["","10702001801","OXYCODONE","5MG","42","Select","Select",""],["","60505257908","ATORVASTATIN","20MG","90","Select","Select",""],["","65702040810","ACCU-CHEK","AVIVA PL","100","Select","Select",""],["","00006027782","JANUVIA","100MG","90","Select","Select",""],["","68180018008","CEFADROXIL","500MG","10","Select","Select",""],["","23155066201","CALCITRIOL","0.25MCG","90","Select","Select",""],["","61314022715","TIMOLOL","0.5% OP","30","Select","Select",""],["","00378632277","VALSART\/HCTZ","160-12.5","90","Select","Select",""],["","65702040810","ACCU-CHEK ","TES AVIVA PL","100","Select","Select",""],["","61314022715","TIMOLOL ","SOL 0.5% OP","30","Select","Select",""],["","68180018008","CEFADROXIL ","CAP 500MG","10","Select","Select",""],["","00378632277","VALSART\/HCTZ ","TAB 160-12.5","90","Select","Select",""],["","69097015812","MELOXICAM ","TAB 7.5MG","28","Select","Select",""],["","23155066201","CALCITRIOL ","CAP 0.25MCG","90","Select","Select",""],["","57896090110","ASPIRIN ","TAB 325MG","42","Select","Select",""],["","10702001801","OXYCODONE ","TAB 5MG","42","Select","Select",""],["","00006027782","JANUVIA ","TAB 100MG","90","Select","Select",""],["","60505257908","ATORVASTATIN ","TAB 20MG","90","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":""}]}]}