{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JONATHAN   M SCOTTI","gend":0,"add":"1324 PARAMORE DR","city":"VIRGINIA BEACH","state":"VA","zip":"23454-9998","dob":"1976-11-28","age":"","mstatus":"","insh":"1311128*01","cliId":"","pno":"757\/419-0659","cno":"757\/419-0659","email":"","ename":"","eno":"","pphy":"MOLLENKOPF, WILLIAM MD","ppno":"757\/352-2030","pcpadd":"1168 FIRST COLONIAL ROAD","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23454,"pcpcounty":"","pcpid":156215,"pcpname":"First Colonial Medical Associates","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/352-2031","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M25.562","Z87.828","I10.","F17.210","K22.70","Z20.828","G89.29","Z98.890","K22.10","M19.90","J45.909","S83.232A","M24.10","M25.462","Z47.89","R07.9","R10.84","E86.0","R11.2","R05.","B37.81","W19.XXXA","R10.9","R06.02","R00.0","M23.322","F17.200","R19.7","Z91.040","Z79.899","N20.0","K76.0","K40.90","R14.0","K42.9","K85.90","R73.02","E11.65","Z79.84","K21.9","E66.9"],"date":["2021-07-26","2021-02-01","2021-08-24","2021-08-24","2021-02-01","2021-02-05","2021-07-26","2021-07-12","2020-01-08","2021-02-01","2021-02-01","2021-03-15","2021-02-24","2021-04-22","2021-06-28","2020-11-06","2020-11-06","2020-11-06","2020-11-06","2020-11-06","2020-12-10","2021-02-24","2021-08-24","2020-11-06","2020-11-06","2021-02-08","2021-02-24","2020-11-06","2021-02-24","2021-02-24","2021-08-30","2021-08-24","2021-08-24","2021-08-24","2021-08-24","2021-08-30","2021-08-30","2021-09-07","2021-09-07","2021-08-24","2021-08-24"],"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":[["","11822527940","ACID ","20MG","30","Select","Select",""],["","00172572860","FAMOTIDINE ","20MG","30","Select","Select",""],["","70710113803","FLUCONAZOLE ","100MG","7","Select","Select",""],["","68382005101","MELOXICAM ","15MG","-30","Select","Select",""],["","65162062710","TRAMADOL ","50MG","30","Select","Select",""],["","70710111208","TIZANIDINE ","4MG","40","Select","Select",""],["","69097081307","GABAPENTIN ","100MG","-90","Select","Select",""],["","42858010201","OXYCOD\/APAP ","5-325MG","60","Select","Select",""],["","11822989470","RA ","81MG EC","14","Select","Select",""],["","55111015430","ONDANSETRON ","8MG","20","Select","Select",""],["","69097052444","DICLOFENAC ","1%","200","Select","Select",""],["","69097084507","CYCLOBENZAPR ","5MG","60","Select","Select",""],["","59651000305","OMEPRAZOLE ","40MG","30","Select","Select",""],["","00093310905","AMOXICILLIN ","500MG","21","Select","Select",""],["","27808008601","HYD ","10-8\/5ML","-100","Select","Select",""],["","31722099601","HYDROCO\/APAP ","5-325MG","12","Select","Select",""],["","11822527940","ACID","20MG","30","Select","Select",""],["","00172572860","FAMOTIDINE","20MG","30","Select","Select",""],["","27808008601","HYD","10-8\/5ML","-100","Select","Select",""],["","70710113803","FLUCONAZOLE","100MG","7","Select","Select",""],["","31722099601","HYDROCO\/APAP","5-325MG","12","Select","Select",""],["","42858010201","OXYCOD\/APAP","5-325MG","60","Select","Select",""],["","11822989470","RA","81MG EC","14","Select","Select",""],["","65162062710","TRAMADOL","50MG","30","Select","Select",""],["","69097081307","GABAPENTIN","100MG","-90","Select","Select",""],["","68382005101","MELOXICAM","15MG","-30","Select","Select",""],["","55111015430","ONDANSETRON","8MG","20","Select","Select",""],["","70710111208","TIZANIDINE","4MG","40","Select","Select",""],["","69097084507","CYCLOBENZAPR","5MG","60","Select","Select",""],["","69097052444","DICLOFENAC","1%","200","Select","Select",""],["","59651000305","OMEPRAZOLE","40MG","30","Select","Select",""],["","00093310905","AMOXICILLIN","500MG","21","Select","Select",""],["","67877056105","METFORMIN","500MG","-60","Select","Select",""],["","00006011231","JANUVIA","50MG","30","Select","Select",""],["","56151147002","TRUE","METER","1","Select","Select",""],["","00193731221","CONTOUR","NEXT","100","Select","Select",""],["","38396031156","LANCETS","THIN 30G","100","Select","Select",""],["","00193654621","BAYER","LANCETS","100","Select","Select",""],["","53885027210","ONETOUCH","VERIO","100","Select","Select",""],["","53885004401","ONE","VERIO FL","1","Select","Select",""],["","56151147002","TRUE ","KIT METER","1","Select","Select",""],["","00193731221","CONTOUR ","TES NEXT","100","Select","Select",""],["","53885004401","ONE ","KIT VERIO FL","1","Select","Select",""],["","53885000810","ONETOUCH ","MIS PLUS 33G","100","Select","Select",""],["","67877056105","METFORMIN ","TAB 500MG","60","Select","Select",""],["","00006011231","JANUVIA ","TAB 50MG","-30","Select","Select",""],["","38396031156","LANCETS ","MIS THIN 30G","100","Select","Select",""],["","00193654621","BAYER ","MIS LANCETS","100","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","",""],["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":""}]}]}