{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"WAYNE   L KEAFER","gend":0,"add":"40 HUNT CLUB BLVD","city":"HAMPTON","state":"VA","zip":"23666-9998","dob":"1956-11-14","age":"","mstatus":"","insh":"900042978*01","cliId":"","pno":"757\/768-2858","cno":"","email":"","ename":"","eno":"","pphy":"LIPSCOMB, NATALIE DO","ppno":"757\/898-7261","pcpadd":"307 COOK ROAD","pcpcity":"YORKTOWN","pcpstate":"VA","pcpzip":23690,"pcpcounty":"","pcpid":"","pcpname":"TIDEWATER PHYSICIANS MULTISPECIALTY GROUP PC","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"TIDEWATER","aligned":"Y","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/890-0139","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R68.89","R79.89","D64.9","Z11.1","M54.5","I10.","E78.1","E11.9","Z00.01","Z13.89","F20.9","K21.9","E66.01","Z12.5","Z79.899","Z68.38","Z00.00"],"date":["2021-09-23","2021-11-18","2021-07-08","2021-09-29","2021-09-29","2021-07-08","2021-07-08","2021-10-20","2021-07-08","2021-07-08","2021-07-08","2021-07-08","2021-07-08","2021-07-08","2021-10-21","2021-10-20","2021-10-20"],"priorHcc":["","","","","","","","","","","","","","","","",""]}}]},{"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":[]},{"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":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","00378021401","HALOPERIDOL                                                           ","2MG","30","Select","Select",""],["","00093719801","FLUOXETINE HYDROCHLORIDE                                              ","40MG","30","Select","Select",""],["","60505267303","ARIPIPRAZOLE                                                          ","5MG","30","Select","Select",""],["","68180046403","SIMVASTATIN                                                           ","40MG","30","Select","Select",""],["","33342005507","PIOGLITAZONE HYDROCHLORIDE                                            ","30MG","30","Select","Select",""],["","00054327099","FLUTICASONE PROPIONATE                                                ","50MCG","16","Select","Select",""],["","52937000120","VASCEPA                                                               ","1GM","120","Select","Select",""],["","60505006501","OMEPRAZOLE                                                            ","20MG","30","Select","Select",""],["","00904131546","BISMATROL                                                             ","262MG","30","Select","Select",""],["","68462019005","NAPROXEN                                                              ","500MG","60","Select","Select",""],["","57896038124","ANTI-DIARRHEAL                                                        ","2MG","30","Select","Select",""],["","16729014201","CLOZAPINE                                                             ","100MG","180","Select","Select",""],["","17478021505","ATROPINE SULFATE                                                      ","1% OP","5","Select","Select",""],["","46122057578","GNP SENNA LAX                                                         ","8.6MG","30","Select","Select",""],["","00054050823","ICOSAPENT ETHYL                                                       ","1GM","72","Select","Select",""]]}},{"a":[]},{"a":[]},{"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":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["1",""],"comment":["",""],"sub":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"comment":[["","","",""],[""],[""],[""],[""],[""]],"sub":[]}}},{"a":{"indx":["1",""],"comment":["",""],"sub":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"comment":[["","","",""],[""],[""],[""],[""],[""]],"sub":[]}}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":[]}]},{"t":"Mini-Cog","q":[{"a":[]},{"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":"","a13":""}]}]}