{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KARLA WALL","gend":1,"add":"5544 WESTWARD DR","city":"VIRGINIA BEACH","state":"VA","zip":"23464-9998","dob":"1959-01-15","age":"","mstatus":"","insh":"1000616*01","cliId":"","pno":"757\/424-1334","cno":"757\/424-1334","email":"","ename":"","eno":"","pphy":"HADEN, DAVID S MD","ppno":"757\/420-9573","pcpadd":"#101 5505 INDIAN RIVER RD","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23464,"pcpcounty":"","pcpid":107599,"pcpname":"David S Haden MD","plan":"OHP","program":"ACA","lob":"Individual","region":"TIDEWATER","aligned":"","ano":"757\/515-3682","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":["F13.20","F43.22","Z78.0","L82.0","L91.8","F43.20","Z12.4","M84.375A","M79.672","Z79.899","L03.115","Z12.31","M84.375D","Z00.00","I10.","E78.00","F41.1","F51.01","J45.20","M85.89","F33.1","E55.9","L82.1","D22.9","L73.8","M70.62","M70.61","Z12.11","H93.11","F13.21"],"date":["2021-08-26","2021-11-24","2020-10-05","2021-04-13","2021-04-13","2020-01-02","2021-03-01","2020-10-19","2020-12-03","2020-02-17","2020-09-17","2021-11-03","2020-12-03","2021-08-10","2021-08-10","2021-08-10","2021-08-06","2020-08-05","2021-08-06","2021-08-06","2021-08-06","2021-02-25","2021-02-03","2021-02-03","2021-02-03","2021-07-07","2021-07-07","2021-07-06","2021-08-06","2021-11-24"],"priorHcc":["",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":[["","65862069730","VENLAFAXINE","150MG ER","30","Select","Select",""],["","00172392670","DIAZEPAM","5MG","60","Select","Select",""],["","66993001968","ALBUTEROL","HFA","18","Select","Select",""],["","68180012202","CEPHALEXIN","500MG","28","Select","Select",""],["","51645073108","CALCIUM\/D","600-200","60","Select","Select",""],["","45802046564","KETOCONAZOLE","2%","120","Select","Select",""],["","00173068220","VENTOLIN","","18","Select","Select",""],["","69097022416","ALENDRONATE","70MG","12","Select","Select",""],["","65862069730","VENLAFAXINE ","150MG ER","30","Select","Select",""],["","00172392670","DIAZEPAM ","5MG","-60","Select","Select",""],["","00173068220","VENTOLIN ","","18","Select","Select",""],["","66993001968","ALBUTEROL ","HFA","18","Select","Select",""],["","68180012202","CEPHALEXIN ","500MG","28","Select","Select",""],["","69097022416","ALENDRONATE ","70MG","12","Select","Select",""],["","51645073108","CALCIUM\/D ","600-200","60","Select","Select",""],["","45802046564","KETOCONAZOLE ","2%","120","Select","Select",""],["","65862019401","FLUOXETINE ","40MG","30","Select","Select",""],["","65862019401","FLUOXETINE","40MG","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":[[["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","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":""}]}]}