{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ROBERT DESSOFFY JR","gend":0,"add":"6 ISLAND VIEW DR","city":"NEWPORT NEWS","state":"VA","zip":"23602-9998","dob":"1958-06-19","pno":"757\/249-3029","cno":"757\/249-3029","email":"","pphy":"","ppno":"","pcpadd":"","pcpcity":"","pcpstate":"","pcpzip":"","pcpcounty":"","pcpid":"","pcpname":"","insh":"1422542*02","cliId":"","plan":"OHP","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":["G50.1","M54.2","M54.81","S63.501A","D50.8","Z98.84","E55.9","E78.00","I10.","E66.9","R06.00","T14.90XA","Z00.00","R53.83","N43.3","Z68.34","Z88.8","Z79.899","Z88.5","M25.431","R79.1","K85.90","R09.81","H57.89","Z23.","R06.02","R60.0","R06.09","H40.9","M79.669","Z86.711","Z86.718","Z90.49","K85.80","N21.0"],"date":["2021-09-16","2021-09-16","2021-09-16","2021-05-18","2021-11-19","2021-11-19","2021-11-19","2021-11-19","2021-11-19","2021-05-19","2020-10-29","2021-05-18","2021-05-19","2021-05-19","2021-05-19","2021-05-19","2021-10-18","2021-10-18","2021-10-18","2021-05-18","2021-10-18","2021-11-19","2021-11-19","2021-11-19","2021-10-16","2021-10-18","2021-10-18","2021-10-18","2021-10-18","2021-10-18","2021-10-18","2021-10-18","2021-10-18","2021-10-18","2021-10-18"],"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":[["","00378451893","AMLOD\/ATORVA","10-20MG","90","Select","Select",""],["","68462012605","GABAPENTIN","600MG","360","Select","Select",""],["","68462016505","CARVEDILOL","25MG","180","Select","Select",""],["","55111018015","TIZANIDINE","4MG","30","Select","Select",""],["","69452015120","VITAMIN","50000UNT","-26","Select","Select",""],["","16714071301","TAMSULOSIN","0.4MG","-180","Select","Select",""],["","60505257909","ATORVASTATIN","20MG","90","Select","Select",""],["","67877019905","AMLODIPINE","10MG","-90","Select","Select",""],["","49281042050","FLUZONE","2020-21","0","Select","Select",""],["","59267100001","PFIZER","COVID-19","0","Select","Select",""],["","10702000301","PROMETHAZINE","25MG","60","Select","Select",""],["","50111056001","TRAZODONE","50MG","60","Select","Select",""],["","68462015713","ONDANSETRON","4MG ODT","12","Select","Select",""],["","64980030550","DENTA","PLUS","51","Select","Select",""],["","55111018015","TIZANIDINE ","TAB 4MG","30","Select","Select",""],["","59762673101","AMLOD\/ATORVA ","TAB 10-20MG","-90","Select","Select",""],["","68462012605","GABAPENTIN ","TAB 600MG","360","Select","Select",""],["","00378363405","CARVEDILOL ","TAB 25MG","180","Select","Select",""],["","49281042050","FLUZONE ","INJ 2020-21","0","Select","Select",""],["","69452015120","VITAMIN ","CAP 50000UNT","26","Select","Select",""],["","67877019905","AMLODIPINE ","TAB 10MG","90","Select","Select",""],["","16714071301","TAMSULOSIN ","CAP 0.4MG","-180","Select","Select",""],["","60505257909","ATORVASTATIN ","TAB 20MG","90","Select","Select",""],["","59267100001","PFIZER ","INJ COVID-19","0","Select","Select",""],["","10702000301","PROMETHAZINE ","TAB 25MG","60","Select","Select",""],["","50111056001","TRAZODONE ","TAB 50MG","60","Select","Select",""],["","80777027398","MODERNA ","INJ COVID-19","0","Select","Select",""],["","68462015713","ONDANSETRON ","TAB 4MG ODT","12","Select","Select",""],["","64980030550","DENTA ","CRE PLUS","51","Select","Select",""],["","70069013101","TOBRAMYCIN ","SOL 0.3% OP","5","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":""}]}]}