{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CLEOPHAS   D EDMONDS","gend":0,"add":"3776 PEPPERWOOD CT","city":"PORTSMOUTH","state":"VA","zip":"23703-9998","dob":"1961-02-26","age":"","mstatus":"","insh":"1349618*01","cliId":"","pno":"337-9282","cno":"337-9282","email":"","ename":"","eno":"","pphy":"RAMOLIA, MANSUKHLAL R MD","ppno":"757\/483-6401","pcpadd":"4035 TAYLOR RD #K","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":23321,"pcpcounty":"","pcpid":210204,"pcpname":"","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"757\/485-2952, ","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/686-3025","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R06.02","Z03.818","I11.9","I25.10","Z98.61","E78.00","Z68.28","D64.9","E05.00","R13.10","E11.43","I10.","E78.2","E79.0","N52.9","C61.","D64.89","N12.","N17.9","Z20.822","R78.81","E11.9","Z85.46","Z91.041","R50.9","H25.013","I50.9","E05.90","Z23.","E78.5","R79.89","Z83.49","R63.4","H05.20","Q64.70","Z88.8","Z83.3","D50.9","E53.8","R76.9","K62.5","K31.89","K31.7","K92.1","Z20.828","R10.9","N99.114","Z00.00","Z71.9","Z68.31","R04.2","R04.0","K29.50","D51.0","E66.9","Z68.33","Z68.34","Z12.11","Z87.448","R33.9","Z68.35"],"date":["2020-04-21","2020-04-21","2021-07-02","2021-09-17","2021-07-02","2021-07-19","2020-08-25","2021-09-17","2021-09-17","2021-04-23","2021-09-17","2021-09-17","2021-09-17","2021-09-17","2021-09-17","2020-09-29","2020-09-29","2021-01-19","2021-01-19","2021-01-19","2021-01-19","2021-01-19","2021-09-17","2021-01-19","2021-01-19","2020-07-01","2021-09-20","2021-04-23","2021-04-09","2020-02-27","2020-06-05","2021-09-17","2021-07-21","2021-09-17","2021-09-17","2021-09-17","2021-09-17","2021-04-23","2021-04-23","2020-12-18","2021-04-23","2020-09-15","2020-09-15","2021-04-23","2020-05-15","2021-01-19","2020-02-03","2021-07-21","2020-06-26","2020-11-04","2020-08-24","2020-08-24","2020-09-15","2020-12-18","2021-04-23","2021-03-12","2021-07-21","2021-04-23","2021-07-19","2021-07-19","2021-09-17"],"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":[["","00378075710","ATENOLOL","100MG","-180","Select","Select",""],["","67877049090","EZETIMIBE","10MG","30","Select","Select",""],["","60505258008","ATORVASTATIN","40MG","30","Select","Select",""],["","65862020399","LOSARTAN","100MG","90","Select","Select",""],["","68001023900","CLONIDINE","0.3MG","60","Select","Select",""],["","00591554310","ALLOPURINOL","100MG","30","Select","Select",""],["","65702040810","ACCU-CHEK","AVIVA PL","100","Select","Select",""],["","00085113204","PROVENTIL","HFA","7","Select","Select",""],["","67877019910","AMLODIPINE","10MG","30","Select","Select",""],["","70710130207","MESALAMINE","1000MG","60","Select","Select",""],["","68382013210","TAMSULOSIN","0.4MG","30","Select","Select",""],["","16729018317","HYDROCHLOROT","25MG","90","Select","Select",""],["","49884064101","METHIMAZOLE","10MG","60","Select","Select",""],["","65862001805","CEPHALEXIN","250MG","40","Select","Select",""],["","00378668977","PANTOPRAZOLE","40MG","-60","Select","Select",""],["","00904759080","FEROSUL","325MG","60","Select","Select",""],["","00006008061","JANUMET","50-1000","30","Select","Select",""],["","65702028810","FASTCLIX","LANCETS","102","Select","Select",""],["","10006070022","VITAMIN","1000MCG","30","Select","Select",""],["","69452014320","BENZONATATE","100MG","30","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","00378075710","ATENOLOL ","100MG","90","Select","Select",""],["","67877049090","EZETIMIBE ","10MG","30","Select","Select",""],["","65862020399","LOSARTAN ","100MG","90","Select","Select",""],["","60505258008","ATORVASTATIN ","40MG","30","Select","Select",""],["","68001023900","CLONIDINE ","0.3MG","60","Select","Select",""],["","68382013210","TAMSULOSIN ","0.4MG","30","Select","Select",""],["","67877019905","AMLODIPINE ","10MG","30","Select","Select",""],["","00591554310","ALLOPURINOL ","100MG","30","Select","Select",""],["","00006008061","JANUMET ","50-1000","30","Select","Select",""],["","65702040810","ACCU-CHEK ","AVIVA PL","100","Select","Select",""],["","65702028810","FASTCLIX ","LANCETS","102","Select","Select",""],["","69918056030","MESALAMINE ","1000MG","60","Select","Select",""],["","16729018317","HYDROCHLOROT ","25MG","90","Select","Select",""],["","10006070022","VITAMIN ","1000MCG","30","Select","Select",""],["","69452014320","BENZONATATE ","100MG","30","Select","Select",""],["","00085113204","PROVENTIL ","HFA","7","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","00904759080","FEROSUL ","325MG","60","Select","Select",""],["","49884064001","METHIMAZOLE ","5MG","60","Select","Select",""],["","00378668977","PANTOPRAZOLE ","40MG","-60","Select","Select",""],["","65862001805","CEPHALEXIN ","250MG","40","Select","Select",""],["","69315011710","FUROSEMIDE","40MG","60","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":""}]}]}