{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TERRI   E STAWINSKY","gend":1,"add":"716 HILDA PINE DR","city":"CHESAPEAKE","state":"VA","zip":"23322-9998","dob":"1970-06-23","age":"","mstatus":"","insh":"1459571*02","cliId":"","pno":"757\/482-5460","cno":"757\/482-5460","email":"","ename":"","eno":"","pphy":"ATWOOD, RONALD W MD","ppno":"757\/436-1234","pcpadd":"SUITE 100 108 KNELLS RIDGE BLVD","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":23320,"pcpcounty":"","pcpid":101400,"pcpname":"Atwood Family Medical Center","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"757\/404-1262","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/548-3665","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E11.9","I10.","E78.5","K59.00","Z12.11","Z12.31","Z12.39","L50.8"],"date":["2021-11-19","2021-03-26","2021-11-19","2020-01-21","2021-08-30","2021-11-17","2021-11-17","2021-11-02"],"priorHcc":[null,"",null,"",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":[["","00310653004","BYDUREON","2MG","4","Select","Select",""],["","00597015230","JARDIANCE","10MG","30","Select","Select",""],["","00006027754","JANUVIA","100MG","30","Select","Select",""],["","68645058259","METFORMIN","500MG","-60","Select","Select",""],["","68645057390","GLIMEPIRIDE","4MG","60","Select","Select",""],["","64380073706","VITAMIN","50000UNT","12","Select","Select",""],["","68645048054","ATORVASTATIN","10MG","90","Select","Select",""],["","50742061701","METOPROL","100MG ER","90","Select","Select",""],["","68645055554","LISINOPRIL","40MG","90","Select","Select",""],["","00115552210","FENOFIBRATE","160MG","90","Select","Select",""],["","68645048054","ATORVASTATIN ","10MG","90","Select","Select",""],["","00310653004","BYDUREON ","2MG","4","Select","Select",""],["","00006027754","JANUVIA ","100MG","30","Select","Select",""],["","00597015230","JARDIANCE ","10MG","30","Select","Select",""],["","64380073706","VITAMIN ","50000UNT","12","Select","Select",""],["","68645058259","METFORMIN ","500MG","60","Select","Select",""],["","68645057390","GLIMEPIRIDE ","4MG","60","Select","Select",""],["","68645055554","LISINOPRIL ","40MG","90","Select","Select",""],["","50742061701","METOPROL ","100MG ER","90","Select","Select",""],["","00115552210","FENOFIBRATE ","160MG","90","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":""}]}]}