{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" GARY HENLEY","gend":0,"add":"2315 ARKANSAS AVE APT B","city":"NORFOLK","state":"VA","zip":"23513-9998","dob":"1973-08-29","age":"","mstatus":"","insh":"1085228*01","cliId":"","pno":"757\/761-2388","cno":"757\/761-2388, 757\/480-0994","email":"","ename":"","eno":"","pphy":"SNELLINGS, JOHN E MD","ppno":"757\/446-5955","pcpadd":"825 FAIRFAX AVE SUITE 118","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":"23507-9998","pcpcounty":"","pcpid":100070,"pcpname":"EVMS Ghent Family Medicine","plan":"OHP - OPTIMA","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"","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":["M79.89","M25.572","M05.79","Z11.3","Z51.81","M25.472","M79.671","M79.672","M19.071","M19.072","R60.0","Q66.51","Q66.52","M21.41","M21.42","M67.874","S83.91XA","S83.91XD","M25.561","M62.81","M65.872"],"date":["2020-08-19","2020-08-19","2021-06-07","2021-04-13","2021-06-07","2020-08-19","2020-11-23","2020-11-23","2020-11-23","2020-11-23","2020-11-23","2020-11-23","2020-11-23","2020-10-12","2020-10-12","2020-11-18","2020-01-16","2020-01-21","2020-01-21","2020-01-21","2020-11-18"],"priorHcc":["","","","","","","","","","","","","","","","","","","","",""]}},{"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":[["","00074433902","HUMIRA","40MG\/0.8","2","Select","Select",""],["","66993005702","HYDROXYCHLOR","200MG","180","Select","Select",""],["","00591079601","SULFASALAZIN","500MG","-540","Select","Select",""],["","00378064010","PREDNISONE","5MG","40","Select","Select",""],["","00093321992","KETOCONAZOLE","2%","180","Select","Select",""],["","66993096045","METRONIDAZOL","0.75%","45","Select","Select",""],["","70461032003","FLUCLVX","2020-21","0","Select","Select",""],["","80777027315","MODERNA","COVID-19","0","Select","Select",""],["","68180065001","DOXYCYC","50MG","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","",""],["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":""}]}]}