{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" BRUCE E COWELL","gend":0,"add":"508 FERNWOOD FARMS RD","city":"CHESAPEAKE","state":"VA","zip":"23320-9998","dob":"1958-05-09","age":"","mstatus":"","insh":"1363913*01","cliId":"","pno":"757\/436-3384","cno":"757\/436-3384, 757\/487-1000","email":"","ename":"","eno":"","pphy":"MAGNO, ELIZABETH MD","ppno":"757\/424-4442","pcpadd":"6632 INDIAN RIVER RD","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":"23464-9998","pcpcounty":"","pcpid":122066,"pcpname":"Nowcare Volvo","plan":"OHP - OPTIMA","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"","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":["Z01.818","I10.","J34.2","J32.9","J34.3","J33.9","J33.8","R56.9","E78.5","G47.33","E66.9","Z68.36","Z79.82","Z79.899","Z98.890","Z48.89","J34.1","J32.4","K05.6","G47.30","Z00.00","H61.21","G40.309","R09.89","E26.09","Z01.810","I44.0"],"date":["2021-04-21","2021-04-26","2021-04-26","2021-04-26","2021-04-26","2021-04-26","2021-04-26","2021-04-26","2021-04-26","2021-04-26","2021-04-26","2021-04-26","2021-04-26","2021-04-26","2021-04-26","2021-05-27","2021-01-02","2021-01-02","2021-01-02","2021-04-26","2021-05-28","2020-12-23","2020-07-08","2020-07-08","2020-05-27","2021-04-21","2021-04-21"],"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":[["","16729029410","EPLERENONE","50MG","180","Select","Select",""],["","67877019905","AMLODIPINE","10MG","90","Select","Select",""],["","00071036924","DILANTIN","100MG","-150","Select","Select",""],["","50742061701","METOPROL","100MG ER","135","Select","Select",""],["","60505257909","ATORVASTATIN","20MG","90","Select","Select",""],["","68180021709","LOSARTAN\/HCT","100-25","-90","Select","Select",""],["","72647033104","METHYLPRED","4MG","21","Select","Select",""],["","60432026415","FLUTICASONE","50MCG","16","Select","Select",""],["","80777027399","MODERNA","COVID-19","0","Select","Select",""],["","0","","","60","Select","Select",""],["","55111015330","ONDANSETRON","4MG","12","Select","Select",""],["","00143924920","AMOX\/K","875-125","20","Select","Select",""],["","11822042030","SALINE","0.65%","45","Select","Select",""],["","11822037971","SINUS","2300-700","30","Select","Select",""],["","11822145760","RA","0.05%","30","Select","Select",""],["","31722099601","HYDROCO\/APAP","5-325MG","50","Select","Select",""],["","69543038810","KETOROLAC","10MG","20","Select","Select",""],["","67877021901","CEPHALEXIN","500MG","21","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":""}]}]}