{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DALE   N OLD","gend":0,"add":"828 MT PLEASANT RD","city":"CHESAPEAKE","state":"VA","zip":"23322-9998","dob":"1961-10-27","age":"","mstatus":"","insh":"1014365*01","cliId":"","pno":"757\/482-5266","cno":"757\/482-5266","email":"","ename":"","eno":"","pphy":"WEST, DAVID J MD","ppno":"757\/547-9286","pcpadd":"113 GAINSBOROUGH SQ STE 300","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":23320,"pcpcounty":"","pcpid":210342,"pcpname":"","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"757\/646-2266","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/410-0186","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E29.1","Z86.010","R56.9","Z79.02","I10.","C61.","Z95.5","G40.309","Z12.11","L57.0","L82.1","L81.4","D22.9","I78.1","Z71.9","I25.110","I20.8","F32.0","I25.10","R07.2","Z95.1","E78.5","K21.9","Z00.00","Z20.822","E78.2","R73.03","G47.30","U07.1","H02.401","H02.402","H02.831","H02.834","I24.9","I25.119","I25.2","G40.409","Z79.82","Z79.899","Z85.46","R07.89","I25.719","G47.33","Z79.84","Z79.890","H52.12","H52.01","H52.223","H52.4","R74.0","L98.9","H02.413","H00.032","I21.3","R07.9","I25.118","R06.09"],"date":["2021-08-13","2021-02-19","2021-02-19","2021-02-19","2021-11-19","2021-08-13","2020-10-21","2021-01-11","2020-10-02","2021-10-07","2021-10-07","2021-10-07","2021-10-07","2020-10-08","2021-10-07","2020-10-16","2020-10-16","2021-01-11","2021-01-11","2020-09-14","2021-11-19","2020-10-21","2021-01-11","2021-01-11","2021-01-11","2021-11-19","2021-01-11","2021-01-11","2021-01-11","2021-03-30","2021-03-30","2021-03-30","2021-03-30","2020-08-13","2020-10-15","2020-10-15","2020-08-13","2020-10-15","2020-10-15","2020-08-13","2020-08-13","2020-10-15","2020-10-15","2020-10-15","2020-10-15","2021-03-23","2021-03-23","2021-03-23","2021-03-23","2020-04-06","2020-04-06","2021-05-25","2020-07-28","2020-08-13","2020-08-13","2021-11-19","2020-10-15"],"priorHcc":["","","","",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":[["","68180051202","LISINOPRIL","2.5MG","30","Select","Select",""],["","67877019810","AMLODIPINE","5MG","30","Select","Select",""],["","31722071390","PANTOPRAZOLE","40MG","30","Select","Select",""],["","65162021210","PHENYTOIN","100MG","450","Select","Select",""],["","65862020399","LOSARTAN","100MG","-90","Select","Select",""],["","50742061710","METOPROL","100MG ER","30","Select","Select",""],["","57237017190","ROSUVASTATIN","40MG","30","Select","Select",""],["","65862083030","PRASUGREL","10MG","30","Select","Select",""],["","16729018217","HYDROCHLOROT","12.5MG","30","Select","Select",""],["","68382078201","DOXYCYC","50MG","52","Select","Select",""],["","00574402235","BACITRACIN","OP","4","Select","Select",""],["","49884027082","NASCOBAL","500MCG","4","Select","Select",""],["","68180051202","LISINOPRIL ","2.5MG","30","Select","Select",""],["","50742061710","METOPROL ","100MG ER","30","Select","Select",""],["","68180072003","AMLODIPINE ","5MG","30","Select","Select",""],["","65162021210","PHENYTOIN ","100MG","450","Select","Select",""],["","31722070210","LOSARTAN ","100MG","30","Select","Select",""],["","57237017190","ROSUVASTATIN ","40MG","30","Select","Select",""],["","31722071390","PANTOPRAZOLE ","40MG","30","Select","Select",""],["","68382078201","DOXYCYC ","50MG","-52","Select","Select",""],["","65862083030","PRASUGREL ","10MG","90","Select","Select",""],["","16729018201","HYDROCHLOROT ","12.5MG","90","Select","Select",""],["","00574402235","BACITRACIN ","OP","4","Select","Select",""],["","49884027082","NASCOBAL ","500MCG","4","Select","Select",""],["","69097052444","DICLOFENAC","1%","100","Select","Select",""],["","69097052444","DICLOFENAC ","GEL 0.01","100","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":""}]}]}