{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" DAVID L FODRIE","gend":0,"add":"34356 ROCHELLE SWAMP RD","city":"NEWSOMS","state":"VA","zip":"23874-9998","dob":"1965-05-19","age":"","mstatus":"","insh":"1241777*01","cliId":"","pno":"757\/636-8217","cno":"757\/636-8217, 000-0000","email":"","ename":"","eno":"","pphy":"SCHUELE, WERNER K MD","ppno":"757\/547-0688","pcpadd":"HMPT RDS-CONTRACT REP 5000 COX RD S","pcpcity":"GLEN ALLEN","pcpstate":"VA","pcpzip":"23060-9998","pcpcounty":"","pcpid":125390,"pcpname":"","plan":"OHP - OPTIMA","program":"ACA","lob":"Small Group","region":"CENTRAL","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":["L02.512","L03.012","E11.65","E66.9","Z68.41","M79.645","Z12.11","B99.9","M10.9","E11.9","Z79.84","Z00.00","E66.01","Z68.39","Z79.899","Z79.1","M25.511","M54.9","E78.5","Z23.","M79.89","Z01.812","Z20.822","M19.011","H65.03"],"date":["2021-05-04","2021-05-04","2021-04-25","2021-04-25","2021-04-25","2021-04-25","2020-08-31","2021-04-25","2020-04-10","2021-05-04","2021-05-04","2020-04-10","2021-05-04","2021-05-04","2021-05-04","2021-05-04","2020-06-17","2020-06-17","2020-06-17","2021-04-20","2021-04-20","2021-05-01","2021-05-01","2020-09-22","2020-01-22"],"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":[["","00006027731","JANUVIA","100MG","-90","Select","Select",""],["","67877056105","METFORMIN","500MG","120","Select","Select",""],["","67877058901","COLCHICINE","0.6MG","12","Select","Select",""],["","65862001501","AMOXICILLIN","875MG","-20","Select","Select",""],["","60505257909","ATORVASTATIN","20MG","90","Select","Select",""],["","68382005101","MELOXICAM","15MG","30","Select","Select",""],["","31722054301","INDOMETHACIN","50MG","30","Select","Select",""],["","65162027210","SMZ\/TMP","800-160","20","Select","Select",""],["","67877021901","CEPHALEXIN","500MG","40","Select","Select",""],["","31722099601","HYDROCO\/APAP","5-325MG","6","Select","Select",""],["","00406051201","OXYCOD\/APAP","5-325MG","12","Select","Select",""],["","65162046650","IBUPROFEN","800MG","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":[[["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":""}]}]}