{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JOHN   M LESKO","gend":0,"add":"2563 GOLDEN MAPLE DR","city":"SUFFOLK","state":"VA","zip":"23434-9998","dob":"1966-05-03","age":"","mstatus":"","insh":"1355255*01","cliId":"","pno":"757\/809-0833","cno":"757\/809-0833","email":"","ename":"","eno":"","pphy":"CRISOSTOMO, CHRISTEN MD","ppno":"757\/923-9660","pcpadd":"SUITE 3 2401 GODWIN BLVD","pcpcity":"SUFFOLK","pcpstate":"VA","pcpzip":23434,"pcpcounty":"","pcpid":133029,"pcpname":"Cedar Road Medical Associates","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"757\/717-0112","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/923-9665","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E11.9","E78.5","Z00.00","I10.","Z12.5","Z20.828","R68.83","D35.02","R10.9","I25.10","E78.49","E11.59","Z12.2","R91.8","F17.200","F41.9","Z13.89","Z68.33","Z23.","R10.31","E27.9","K29.70","K21.00","Z12.11","K57.30","K44.9","K31.89","R05.","R50.9","Z01.818","Z86.010","K63.89","K31.9","F32.9","G43.909","G40.909","F17.210","Z79.4","Z96.41","I73.9","M54.5","R07.9","M47.816","M47.817","M46.96","M79.10","R11.2","R07.0","K21.9","K59.00","R53.83","J30.9","L73.2","Z71.9","G47.00","N48.9"],"date":["2021-09-14","2021-09-14","2021-09-09","2021-09-14","2021-09-09","2021-01-05","2021-01-05","2020-08-20","2020-08-20","2020-10-26","2020-08-20","2020-08-20","2021-06-03","2021-06-03","2021-10-11","2020-03-16","2021-05-19","2020-07-30","2021-09-14","2020-07-31","2020-07-31","2020-10-26","2020-10-26","2020-10-26","2020-10-26","2020-10-26","2020-10-26","2021-01-05","2021-01-05","2020-10-22","2020-10-26","2020-10-26","2020-10-26","2020-10-26","2020-10-26","2020-10-26","2021-06-03","2020-10-26","2020-10-26","2020-09-15","2020-01-15","2020-01-15","2020-01-15","2020-01-15","2020-01-15","2020-11-11","2020-06-30","2020-06-30","2020-08-27","2020-08-27","2021-05-19","2021-05-19","2021-06-14","2021-06-14","2021-07-26","2021-10-11"],"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":[["","55111019690","CLOPIDOGREL","75MG","90","Select","Select",""],["","70010049101","METFORMIN","500MG ER","60","Select","Select",""],["","31722070290","LOSARTAN","100MG","30","Select","Select",""],["","68462063945","NITROGLYCERN","0.4MG","25","Select","Select",""],["","65862001230","SERTRALINE","50MG","30","Select","Select",""],["","67877019805","AMLODIPINE","5MG","30","Select","Select",""],["","00591024110","LORAZEPAM","1MG","30","Select","Select",""],["","72205002590","ATORVASTATIN","80MG","90","Select","Select",""],["","43598044874","NICOTINE","21MG\/24H","42","Select","Select",""],["","58160082311","SHINGRIX","50\/0.5ML","1","Select","Select",""],["","70710112101","DOXYCYCLINE","50MG","-60","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","00172572860","FAMOTIDINE","20MG","60","Select","Select",""],["","68382078201","DOXYCYC","50MG","60","Select","Select",""],["","70010049101","METFORMIN ","500MG ER","60","Select","Select",""],["","55111019690","CLOPIDOGREL ","75MG","90","Select","Select",""],["","31722070290","LOSARTAN ","100MG","30","Select","Select",""],["","65862001230","SERTRALINE ","50MG","30","Select","Select",""],["","68462063945","NITROGLYCERN ","0.4MG","25","Select","Select",""],["","67877019890","AMLODIPINE ","5MG","30","Select","Select",""],["","00591024110","LORAZEPAM ","1MG","30","Select","Select",""],["","72205002590","ATORVASTATIN ","80MG","90","Select","Select",""],["","58160082311","SHINGRIX ","50\/0.5ML","1","Select","Select",""],["","43598044874","NICOTINE ","21MG\/24H","28","Select","Select",""],["","00172572860","FAMOTIDINE ","20MG","60","Select","Select",""],["","70710112101","DOXYCYCLINE ","50MG","60","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","68382078201","DOXYCYC ","50MG","60","Select","Select",""],["","65862016001","ZOLPIDEM ","10MG","30","Select","Select",""],["","00074012403","HUMIRA ","CD\/UC\/HS","3","Select","Select",""],["","65862016001","ZOLPIDEM","10MG","30","Select","Select",""],["","00074012403","HUMIRA","CD\/UC\/HS","3","Select","Select",""],["","59267100001","PFIZER","COVID-19","0","Select","Select",""],["","59267100001","PFIZER ","INJ COVID-19","0","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":""}]}]}