{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LORA REINERT","gend":1,"add":"716 GLORIA DR","city":"CHESAPEAKE","state":"VA","zip":"23322-9998","dob":"1970-05-01","age":"","mstatus":"","insh":"1208584*02","cliId":"","pno":"757\/407-2751","cno":"757\/407-2751","email":"","ename":"","eno":"","pphy":"MARKS, CHARLES MD","ppno":"757\/410-4580","pcpadd":"1464 MT PLEASANT RD SUITES 13 AND 1","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":23322,"pcpcounty":"","pcpid":159762,"pcpname":"","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"757\/482-9382","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/410-4591","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F43.23","F90.0","F41.9","I10.","E78.00","R73.01","Z79.899","F33.0","H92.01","Z20.828","E11.9","Z12.11"],"date":["2021-11-11","2021-11-11","2020-11-30","2021-05-17","2021-05-17","2021-04-23","2021-05-17","2021-04-23","2020-11-30","2020-11-17","2021-05-17","2021-10-28"],"priorHcc":[null,null,"","","","","","","","","",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":[["","65862020299","LOSARTAN","50MG","-30","Select","Select",""],["","68462053047","CLOBETASOL","0.05%","-45","Select","Select",""],["","29300012810","HYDROCHLOROT","25MG","30","Select","Select",""],["","68180031909","BUPROPN","150MG XL","90","Select","Select",""],["","00228202796","ALPRAZOLAM","0.25MG","30","Select","Select",""],["","00378718505","METFORMIN","500MG","-30","Select","Select",""],["","23155050105","HYDROXYZ","25MG","30","Select","Select",""],["","29300012810","HYDROCHLOROT ","25MG","30","Select","Select",""],["","68180037703","LOSARTAN ","50MG","30","Select","Select",""],["","68462053047","CLOBETASOL ","0.05%","-45","Select","Select",""],["","68180031909","BUPROPN ","150MG XL","90","Select","Select",""],["","00228202796","ALPRAZOLAM ","0.25MG","30","Select","Select",""],["","23155050105","HYDROXYZ ","25MG","30","Select","Select",""],["","00378718505","METFORMIN ","500MG","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":[[["Yes","Select","","","","","Select","",""],["Yes","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":""}]}]}