{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JEFF   L BEAN","gend":0,"add":"9400 RIVER RD","city":"SOUTH CHESTERFIELD","state":"VA","zip":"23803-9998","dob":"1967-07-21","age":"","mstatus":"","insh":"1369846*01","cliId":"","pno":"804\/868-8385","cno":"804\/868-8385","email":"","ename":"","eno":"","pphy":"SHANDILYA, LOKNATH MD","ppno":"804\/451-3650","pcpadd":"95 MEDICAL PARK BLVD","pcpcity":"PETERSBURG","pcpstate":"VA","pcpzip":23805,"pcpcounty":"","pcpid":117518,"pcpname":"","plan":"OHP","program":"ACA","lob":"Small Group","region":"CENTRAL","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":["R06.83","R40.0","I10.","F17.200","I15.9","I11.9","J45.30","E78.2","F17.210","R06.02","R07.9","J30.89","Z72.0","Z12.11","R03.0","J45.909","F17.290","Z87.891"],"date":["2020-07-02","2020-07-02","2020-07-02","2020-07-02","2020-06-21","2020-06-24","2020-06-19","2020-06-19","2020-06-19","2020-06-21","2020-06-21","2020-03-15","2020-03-15","2021-08-30","2020-06-24","2020-03-17","2020-06-24","2020-06-21"],"priorHcc":["","","","","","","","","","","","","",null,"","","",""]}},{"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":[["","68180051703","LISINOPRIL ","40MG","30","Select","Select",""],["","59779044870","CVS ","21MG\/24H","-30","Select","Select",""],["","60505082901","FLUTICASONE ","50MCG","16","Select","Select",""],["","00173068220","VENTOLIN ","","18","Select","Select",""],["","00093317431","ALBUTEROL ","HFA","8","Select","Select",""],["","00536589688","NICOTINE ","21MG\/24H","28","Select","Select",""],["","53746051401","SPIRONOLACT ","50MG","90","Select","Select",""],["","68180072003","AMLODIPINE ","5MG","-90","Select","Select",""],["","43386035801","HYDROCO\/APAP ","10-325MG","10","Select","Select",""],["","00093310905","AMOXICILLIN ","500MG","21","Select","Select",""],["","00054418425","DEXAMETHASON ","4MG","5","Select","Select",""],["","70377002911","ATORVASTATIN ","40MG","90","Select","Select",""],["","49483060350","IBUPROFEN ","600MG","20","Select","Select",""],["","60505082901","FLUTICASONE","50MCG","16","Select","Select",""],["","68180098103","LISINOPRIL","20MG","30","Select","Select",""],["","59779060027","CVS","81MG EC","30","Select","Select",""],["","00536589688","NICOTINE","21MG\/24H","28","Select","Select",""],["","00173068220","VENTOLIN","","18","Select","Select",""],["","00093317431","ALBUTEROL","HFA","8","Select","Select",""],["","70377002911","ATORVASTATIN","40MG","90","Select","Select",""],["","68180072003","AMLODIPINE","5MG","90","Select","Select",""],["","53746051401","SPIRONOLACT","50MG","90","Select","Select",""],["","49483060350","IBUPROFEN","600MG","20","Select","Select",""],["","00054418425","DEXAMETHASON","4MG","5","Select","Select",""],["","43386035801","HYDROCO\/APAP","10-325MG","10","Select","Select",""],["","00093310905","AMOXICILLIN","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":""}]}]}