{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TABOR   V EMMERSON","gend":0,"add":"7739 CASTLETON PL APT 2","city":"NORFOLK","state":"VA","zip":"23505-9998","dob":"1983-09-26","age":"","mstatus":"","insh":"1085435*01","cliId":"","pno":"757\/281-9685","cno":"757\/281-9685","email":"","ename":"","eno":"","pphy":"TANNOUS, GEORGE MD","ppno":"757\/305-1797","pcpadd":"STE 220 828 HEALTHY WAY","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23462,"pcpcounty":"","pcpid":143824,"pcpname":"BON SECOURS MEDICAL ASSOCIATES","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"000\/000-0000","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":["Z23.","I10.","Z00.00","H60.319"],"date":["2021-04-27","2020-12-09","2020-10-28","2020-07-23"],"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":[["","61314064610","NEO\/POLY\/HC","1% OTIC","10","Select","Select",""],["","00069046903","CHANTIX","1MG","-56","Select","Select",""],["","65862001501","AMOXICILLIN","875MG","-20","Select","Select",""],["","68180072003","AMLODIPINE","5MG","-90","Select","Select",""],["","62332020530","AMLOD\/VALSAR","5-160MG","-90","Select","Select",""],["","64380080707","IBUPROFEN","800MG","90","Select","Select",""],["","29300012810","HYDROCHLOROT","25MG","90","Select","Select",""],["","68180072003","AMLODIPINE ","5MG","90","Select","Select",""],["","64380080707","IBUPROFEN ","800MG","90","Select","Select",""],["","65862001501","AMOXICILLIN ","875MG","20","Select","Select",""],["","61314064610","NEO\/POLY\/HC ","1% OTIC","-10","Select","Select",""],["","00069047103","CHANTIX ","0.5& 1MG","-53","Select","Select",""],["","62332020530","AMLOD\/VALSAR ","5-160MG","-90","Select","Select",""],["","29300012810","HYDROCHLOROT ","25MG","90","Select","Select",""],["","43598057430","TADALAFIL","10MG","6","Select","Select",""],["","43598057430","TADALAFIL ","TAB 10MG","6","Select","Select",""],["","66993001968","ALBUTEROL ","AER HFA","18","Select","Select",""],["","00173068220","VENTOLIN ","AER ","-18","Select","Select",""],["","51672128202","TRIAMCINOLON ","CRE 0.001","-60","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":""}]}]}