{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"GILBERT   LEE TRAUTMAN","gend":0,"add":"9264 1ST VIEW ST","city":"NORFOLK","state":"VA","zip":"23503-9998","dob":"1967-03-29","age":"","mstatus":"","insh":"1328516*01","cliId":"","pno":"757\/581-8675","cno":"757\/581-8675","email":"","ename":"","eno":"","pphy":"FEE, ERIC MD","ppno":"757\/587-0157","pcpadd":"7924 CHESAPEAKE BLVD","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23518,"pcpcounty":"","pcpid":670139,"pcpname":"Bayview Medical Center","plan":"OHP","program":"ACA","lob":"Individual","region":"TIDEWATER","aligned":"","ano":"757\/581-8675","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":["B20.","G47.09","G47.00","Z21.","F41.0","F41.9","F32.9","F43.10","F41.1","F10.11","F15.21","Z87.09","Z00.00","Z12.5","Z13.220","E78.2","Z23.","Z71.89","R06.83","F31.81","Z20.828"],"date":["2021-07-13","2020-03-10","2020-10-28","2021-07-07","2020-10-28","2020-10-28","2021-07-15","2021-07-15","2021-07-15","2021-06-14","2021-07-15","2020-06-22","2020-10-28","2020-10-28","2020-10-28","2021-07-13","2021-07-13","2020-04-13","2020-04-13","2021-05-03","2020-06-28"],"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":[["","61958190101","GENVOYA","","-30","Select","Select",""],["","65862016001","ZOLPIDEM","10MG","30","Select","Select",""],["","65862037401","ESCITALOPRAM","10MG","60","Select","Select",""],["","00228202996","ALPRAZOLAM","0.5MG","90","Select","Select",""],["","55111012105","ATORVASTATIN","10MG","90","Select","Select",""],["","33332032001","AFLURIA","2020-21","0","Select","Select",""],["","68462010805","TOPIRAMATE","25MG","30","Select","Select",""],["","61958190101","GENVOYA ","","30","Select","Select",""],["","65862016001","ZOLPIDEM ","10MG","30","Select","Select",""],["","65862037401","ESCITALOPRAM ","10MG","60","Select","Select",""],["","33332032001","AFLURIA ","2020-21","0","Select","Select",""],["","00228202996","ALPRAZOLAM ","0.5MG","90","Select","Select",""],["","55111012105","ATORVASTATIN ","10MG","30","Select","Select",""],["","68462010805","TOPIRAMATE ","25MG","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":[[["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":""}]}]}