{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" JAMES J HAYDEN JR","gend":0,"add":"2272 SEABOARD ROAD","city":"VIRGINIA BEACH","state":"VA","zip":"23456-9998","dob":"1961-05-17","age":"","mstatus":"","insh":"1240730*01","cliId":"","pno":"252\/202-7774","cno":"252\/202-7774, ","email":"","ename":"","eno":"","pphy":"STEIER, HOWARD C MD","ppno":"757\/481-3811","pcpadd":"# 102 1004 FIRST COLONIAL R","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":"23454-9998","pcpcounty":"","pcpid":118167,"pcpname":"","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":["M25.562","M17.12","K81.9","R10.11","R10.13","R10.9","K29.00","R05.","R07.9","F17.210","I10.","Z79.01","Z86.718","Z82.49","Z88.0","Z88.8","Z96.651","R06.02","D68.59","Z12.11","N49.2","R07.89","R00.2","Z83.3","L82.1","D48.5","L57.4","L30.0","I80.9","I49.1","I49.3"],"date":["2020-09-15","2020-09-15","2021-06-23","2021-06-23","2021-06-23","2021-06-21","2021-06-21","2020-04-17","2021-06-20","2021-06-19","2021-06-19","2021-06-19","2021-06-19","2021-06-19","2021-06-19","2021-06-19","2021-06-19","2021-06-20","2020-04-17","2020-08-31","2020-12-30","2021-02-09","2021-02-09","2021-02-09","2021-01-26","2021-01-26","2021-01-26","2021-01-26","2020-02-14","2021-02-09","2021-02-09"],"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":[["","00003089321","ELIQUIS","2.5MG","180","Select","Select",""],["","67877057305","BENZONATATE","100MG","-30","Select","Select",""],["","65862068890","SILDENAFIL","20MG","30","Select","Select",""],["","00527193206","CLARITHROMYC","500MG","14","Select","Select",""],["","68308025010","ERYTHROMYCIN","250MG EC","60","Select","Select",""],["","65862067899","ALPRAZOLAM","1MG","30","Select","Select",""],["","49483060450","IBUPROFEN","800MG","15","Select","Select",""],["","65862086001","FAMOTIDINE","40MG","90","Select","Select",""],["","24338011013","ERYTHROM","400MG","-15","Select","Select",""],["","68180016013","AZITHROMYCIN","250MG","6","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":""}]}]}