{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ADAM   J KEEFE","gend":0,"add":"6403 PELICAN CRESCENT NORTH","city":"SUFFOLK","state":"VA","zip":"23435-9998","dob":"1973-11-05","age":"","mstatus":"","insh":"1206830*01","cliId":"","pno":"757\/237-2730","cno":"757\/237-2730","email":"","ename":"","eno":"","pphy":"HIGGINS, CHRISTINE 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\/479-0626","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.","Z03.818","G47.33","E34.9","E55.9","E78.2","G43.909","N40.1","R73.01","D68.2","G47.30","Z79.01","D68.69","D68.59"],"date":["2021-01-30","2020-12-31","2021-06-14","2021-04-20","2021-04-20","2021-04-27","2021-04-27","2021-04-20","2021-04-20","2020-10-21","2020-10-21","2020-10-21","2021-07-19","2021-07-21"],"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":[["","51672403203","WARFARIN","5MG","120","Select","Select",""],["","58160088552","FLUARIX","2020-21","0","Select","Select",""],["","00143924920","AMOX\/K","875-125","20","Select","Select",""],["","35573041030","TADALAFIL","5MG","90","Select","Select",""],["","00713063437","MOMETASONE","0.10%","45","Select","Select",""],["","51672403101","WARFARIN ","4MG","90","Select","Select",""],["","58160088552","FLUARIX ","2020-21","0","Select","Select",""],["","00713063437","MOMETASONE ","0.10%","45","Select","Select",""],["","35573041030","TADALAFIL ","5MG","90","Select","Select",""],["","00143924920","AMOX\/K ","875-125","20","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":""}]}]}