{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"PATRICK KAY","gend":0,"add":"8 HAYWAGON TRL","city":"HAMPTON","state":"VA","zip":"23669-9998","dob":"1980-08-13","age":"","mstatus":"","insh":"1060659*02","cliId":"","pno":"757\/435-5297","cno":"757\/435-5297","email":"","ename":"","eno":"","pphy":"ARNOLD, HELEN G DO","ppno":"757\/850-1311","pcpadd":"12715 WARWICK BLVD STE O","pcpcity":"NEWPORT NEWS","pcpstate":"VA","pcpzip":23606,"pcpcounty":"","pcpid":118380,"pcpname":"Commonwealth Family Practice","plan":"OHP","program":"ACA","lob":"Individual","region":"TIDEWATER","aligned":"","ano":"757\/594-0663","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/269-4406","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R51.","G51.0","H02.401","M54.2","M54.5","G89.29","M43.6","M54.6","Q28.3","R07.9","M79.18","S13.4XXA","V89.2XXD","Z68.26","Z12.5","Z00.00","M79.643","Z68.24","R51.9","Z11.1"],"date":["2020-06-26","2020-09-15","2020-06-26","2021-08-06","2020-08-03","2020-08-03","2020-07-08","2020-02-04","2020-09-15","2020-08-03","2020-08-03","2020-01-02","2020-01-02","2020-01-02","2021-05-11","2021-05-18","2021-05-18","2021-05-18","2021-08-06","2021-10-19"],"priorHcc":["","","","","","","","","","","","","","","","","","","",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":[["","00378427677","VALACYCLOVIR","1GM","21","Select","Select",""],["","00591544305","PREDNISONE","20MG","21","Select","Select",""],["","80777027399","MODERNA","COVID-19","0","Select","Select",""],["","00378427677","VALACYCLOVIR ","1GM","21","Select","Select",""],["","00591544305","PREDNISONE ","20MG","21","Select","Select",""],["","80777027399","MODERNA ","COVID-19","0","Select","Select",""],["","52817033010","CYCLOBENZAPR ","5MG","-15","Select","Select",""],["","52817033010","CYCLOBENZAPR","5MG","15","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","",""],["No","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":""}]}]}