{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KENNETH   W BARBER","gend":0,"add":"2016 ROKEBY AVE","city":"CHESAPEAKE","state":"VA","zip":"23320-9998","dob":"1962-09-13","age":"","mstatus":"","insh":"1126918*02","cliId":"","pno":"757\/366-5198","cno":"757\/366-5198","email":"","ename":"","eno":"","pphy":"FREEMAN, E THOMAS MD","ppno":"757\/420-8297","pcpadd":"1016 JUSTIS ST","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":23325,"pcpcounty":"","pcpid":163774,"pcpname":"INDIAN RIVER FAMILY PRACTICE","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"757\/487-3458","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/523-5639","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["B18.2","K76.9","K74.60","Z68.20","R07.9","I25.10","I25.2","F17.200","R11.0","Z12.11","F14.10","Z20.822","I10.","E78.5","R10.11","E03.9","I25.119","Z72.0","R39.15","E78.00","J45.40","E78.2","R53.83","Z20.828"],"date":["2020-07-22","2020-02-13","2021-04-07","2020-07-22","2021-02-25","2021-02-25","2021-02-25","2021-02-25","2021-02-25","2021-08-30","2021-01-23","2021-01-23","2021-05-17","2021-05-17","2021-04-07","2021-02-25","2021-05-17","2021-05-17","2020-01-23","2020-01-23","2020-01-23","2020-08-31","2020-08-31","2020-10-27"],"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":[["","69238183107","LEVOTHYROXIN","50MCG","90","Select","Select",""],["","68001033203","LISINOPRIL","2.5MG","90","Select","Select",""],["","16729018317","HYDROCHLOROT","25MG","90","Select","Select",""],["","68001035603","METOPROL","25MG ER","30","Select","Select",""],["","46122018087","ASPIRIN","81MG EC","30","Select","Select",""],["","67877019810","AMLODIPINE","5MG","60","Select","Select",""],["","46122061587","GNP","81MG EC","30","Select","Select",""],["","00781261305","AMOXICILLIN","500MG","24","Select","Select",""],["","00406012310","HYDROCO\/APAP","5-325MG","12","Select","Select",""],["","68001033203","LISINOPRIL ","2.5MG","90","Select","Select",""],["","16729018317","HYDROCHLOROT ","25MG","90","Select","Select",""],["","46122018087","ASPIRIN ","81MG EC","30","Select","Select",""],["","68001035603","METOPROL ","25MG ER","30","Select","Select",""],["","69238183107","LEVOTHYROXIN ","50MCG","90","Select","Select",""],["","46122061587","GNP ","81MG EC","30","Select","Select",""],["","67877019810","AMLODIPINE ","5MG","60","Select","Select",""],["","00406012310","HYDROCO\/APAP ","5-325MG","12","Select","Select",""],["","00781261305","AMOXICILLIN ","500MG","24","Select","Select",""],["","27808015503","ROSUVASTATIN ","TAB 5MG","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":""}]}]}