{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LAWRENCE   A KESSER","gend":0,"add":"715 LOUDON AVE","city":"PORTSMOUTH","state":"VA","zip":"23707-9998","dob":"1967-04-11","age":"","mstatus":"","insh":"1388110*01","cliId":"","pno":"757\/623-8836","cno":"757\/623-8836","email":"","ename":"","eno":"","pphy":"JONES, ERIC L MD","ppno":"757\/399-0759","pcpadd":"3315 HIGH ST","pcpcity":"PORTSMOUTH","pcpstate":"VA","pcpzip":23707,"pcpcounty":"","pcpid":162911,"pcpname":"","plan":"OHP","program":"ACA","lob":"Individual","region":"TIDEWATER","aligned":"","ano":"757\/714-1810","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/397-8951","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z30.2","R13.10","K21.9","Z86.010","K63.5","K57.90","K21.00","K44.9","K43.2","K51.40","K62.1","K43.0","F43.20","Z01.812","Z20.822","Z01.818","Z12.11","K57.30","K64.0","Z79.899","Z96.653","Z87.891","Z87.19","Z98.890","G47.30","D53.9","Z98.0","D12.2","D12.8","G47.33","Z72.821","R06.83","Z78.9","Z00.00","Z68.30","Z23."],"date":["2020-05-28","2021-05-10","2021-06-21","2021-05-10","2021-05-10","2021-05-10","2021-05-10","2021-05-10","2021-06-21","2021-05-10","2021-05-10","2021-06-21","2020-07-28","2021-05-07","2021-05-07","2021-05-07","2021-05-10","2021-05-10","2021-05-10","2021-06-21","2021-05-10","2021-06-21","2021-06-21","2021-06-21","2021-06-21","2021-06-21","2021-05-10","2021-05-10","2021-05-10","2021-09-22","2021-09-15","2021-09-15","2021-09-15","2021-11-16","2021-11-16","2021-11-16"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","",null,"","","",null,null,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":[["","00781286810","OMEPRAZOLE","20MG DR","30","Select","Select",""],["","29300014901","QUETIAPINE","100MG","30","Select","Select",""],["","65862001330","SERTRALINE","100MG","30","Select","Select",""],["","50383066730","LIDO\/PRILOCN","2.5-2.5%","30","Select","Select",""],["","59267100001","PFIZER","COVID-19","0","Select","Select",""],["","69344014443","SPRIX","15.75MG","5","Select","Select",""],["","31722094901","OXYCOD\/APAP","5-325MG","30","Select","Select",""],["","65862001330","SERTRALINE ","100MG","30","Select","Select",""],["","29300014901","QUETIAPINE ","100MG","30","Select","Select",""],["","00781286810","OMEPRAZOLE ","20MG DR","30","Select","Select",""],["","50383066730","LIDO\/PRILOCN ","2.5-2.5%","-30","Select","Select",""],["","69344014443","SPRIX ","15.75MG","5","Select","Select",""],["","59267100001","PFIZER ","COVID-19","0","Select","Select",""],["","31722094901","OXYCOD\/APAP ","5-325MG","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":[[["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":""}]}]}