{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"GARNETT   E PORTER JR","gend":0,"add":"248 HAVILAND RD","city":"CHESAPEAKE","state":"VA","zip":"23320-9998","dob":"1958-12-31","age":"","mstatus":"","insh":"1386559*01","cliId":"","pno":"757\/355-2228","cno":"757\/355-2228","email":"","ename":"","eno":"","pphy":"FREEMAN, E THOMAS MD","ppno":"757\/420-8297","pcpadd":"1016 JUSTIS ST","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":23325,"pcpcounty":"","pcpid":163774,"pcpname":"INDIAN RIVER FAMILY PRACTICE","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"757\/435-0909","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":["Z01.810","K08.89","I48.0","I10.","Z79.01","C73.","E05.90","C44.40","D04.4","E89.0","Z92.3","Z85.828","Z85.850","Z87.891","Z79.890","Z79.899","S69.90XA","C44.329","C44.311","S62.515B","Z23.","I48.91","M79.645","C44.92","R94.31","C44.42","Z98.890","D48.5","S61.012A","E27.9","C44.612","R79.89","I42.0"],"date":["2020-07-13","2020-07-13","2020-07-13","2021-05-09","2021-05-09","2020-09-03","2020-09-03","2020-03-28","2020-04-09","2020-09-03","2020-04-09","2020-04-09","2020-04-09","2020-04-09","2020-04-09","2021-05-09","2021-05-09","2020-02-03","2020-02-03","2021-05-09","2021-05-09","2021-05-09","2021-05-09","2020-02-28","2020-03-28","2020-04-09","2020-03-30","2020-01-07","2021-05-09","2020-09-03","2020-02-04","2020-09-03","2020-09-03"],"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":[["","65862020399","LOSARTAN","100MG","90","Select","Select",""],["","69238183801","LEVOTHYROXIN","150MCG","30","Select","Select",""],["","00003089421","ELIQUIS","5MG","180","Select","Select",""],["","68180095603","CLOBETASOL","0.05%","-45","Select","Select",""],["","00363007564","BACITRACIN","500\/GM","28","Select","Select",""],["","65862001705","AMOXICILLIN","500MG","21","Select","Select",""],["","62559038101","FLECAINIDE","100MG","180","Select","Select",""],["","16729018201","HYDROCHLOROT","12.5MG","90","Select","Select",""],["","60505003306","PENTOXIFYLLI","400MG ER","-90","Select","Select",""],["","00378001805","METOPROL","25MG","180","Select","Select",""],["","00406012305","HYDROCO\/APAP","5-325MG","12","Select","Select",""],["","00093314705","CEPHALEXIN","500MG","-28","Select","Select",""],["","11917007472","VITAMIN","1000UNIT","30","Select","Select",""],["","64380080807","IBUPROFEN","600MG","30","Select","Select",""],["","65862020399","LOSARTAN ","100MG","90","Select","Select",""],["","68180095603","CLOBETASOL ","0.05%","45","Select","Select",""],["","69238183801","LEVOTHYROXIN ","150MCG","30","Select","Select",""],["","00003089421","ELIQUIS ","5MG","180","Select","Select",""],["","00363007564","BACITRACIN ","500\/GM","28","Select","Select",""],["","62559038101","FLECAINIDE ","100MG","180","Select","Select",""],["","00378001805","METOPROL ","25MG","90","Select","Select",""],["","65862001705","AMOXICILLIN ","500MG","21","Select","Select",""],["","16729018201","HYDROCHLOROT ","12.5MG","90","Select","Select",""],["","00093314705","CEPHALEXIN ","500MG","15","Select","Select",""],["","00406012305","HYDROCO\/APAP ","5-325MG","12","Select","Select",""],["","60505003306","PENTOXIFYLLI ","400MG ER","-90","Select","Select",""],["","11917007472","VITAMIN ","1000UNIT","30","Select","Select",""],["","64380080807","IBUPROFEN ","600MG","30","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":""}]}]}