{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JASON   T DAW","gend":0,"add":"2028 SUNSET MAPLE LN","city":"CHESAPEAKE","state":"VA","zip":"23323-9998","dob":"1983-05-09","age":"","mstatus":"","insh":"1329676*01","cliId":"","pno":"757\/240-9800","cno":"757\/240-9800","email":"","ename":"","eno":"","pphy":"KAPOOR, SONIA MD","ppno":"757\/548-0076","pcpadd":"SUITE 100 725 VOLVO PKWY","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":23320,"pcpcounty":"","pcpid":134965,"pcpname":"Family Physicians of Chesapeake","plan":"OHP","program":"ACA","lob":"Individual","region":"TIDEWATER","aligned":"","ano":"757\/240-9800","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":["D35.2","E10.9","Z96.41","E03.9","J20.9","R19.7"],"date":["2020-12-28","2020-12-28","2020-12-15","2020-12-28","2020-03-11","2020-07-13"],"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":[["","00002751001","HUMALOG","100\/ML","50","Select","Select",""],["","00456046101","ARMOUR","120MG","30","Select","Select",""],["","00143980305","DOXYCYCL","100MG","14","Select","Select",""],["","00173068220","VENTOLIN","","18","Select","Select",""],["","66993001968","ALBUTEROL","HFA","18","Select","Select",""],["","00093542088","CABERGOLINE","0.5MG","-16","Select","Select",""],["","00002773701","INSULIN","100\/ML","60","Select","Select",""],["","99073070805","FREESTYLE MIS LITE","LITE","1","Select","Select",""],["","42192032801","NP","120MG","-90","Select","Select",""],["","00002751001","HUMALOG ","100\/ML","150","Select","Select",""],["","00456046101","ARMOUR ","120MG","30","Select","Select",""],["","00093542088","CABERGOLINE ","0.5MG","16","Select","Select",""],["","00143980305","DOXYCYCL ","100MG","14","Select","Select",""],["","66993001968","ALBUTEROL ","HFA","18","Select","Select",""],["","00173068220","VENTOLIN ","","18","Select","Select",""],["","66733077301","INSULIN ","100\/ML","160","Select","Select",""],["","42192032801","NP ","120MG","90","Select","Select",""],["","99073070805","FREESTYLE    MIS LITE","LITE","1","Select","Select",""],["","00088222033","LANTUS ","100\/ML","-10","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":""}]}]}