{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ANDREW WHALEN","gend":0,"add":"4604 HIGH ST W","city":"PORTSMOUTH","state":"VA","zip":"23703-9998","dob":"1974-11-14","age":"","mstatus":"","insh":"1560507*01","cliId":"","pno":"757\/778-7928","cno":"757\/778-7928","email":"","ename":"","eno":"","pphy":"MANDELL JR, M STEPHEN MD","ppno":"804\/633-5840","pcpadd":"121 COURTHOUSE LN","pcpcity":"BOWLING GREEN","pcpstate":"VA","pcpzip":22427,"pcpcounty":"","pcpid":195552,"pcpname":"","plan":"OHP","program":"ACA","lob":"Individual","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/633-4438","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["H43.392","H00.014","E29.1","I10.","E78.5","R35.0","R31.29","N40.1","R39.15","Z30.09","N13.8","B08.4"],"date":["2021-06-11","2021-06-11","2021-06-09","2021-06-09","2021-06-09","2021-08-18","2021-08-18","2021-08-18","2021-08-18","2021-08-18","2021-08-18","2021-10-22"],"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":[["","68180031909","BUPROPN ","150MG XL","90","Select","Select",""],["","68180047803","SIMVASTATIN ","10MG","-90","Select","Select",""],["","65162055610","TEMAZEPAM ","15MG","60","Select","Select",""],["","00406012305","HYDROCO\/APAP ","5-325MG","12","Select","Select",""],["","68180031909","BUPROPN","150MG XL","90","Select","Select",""],["","68180047803","SIMVASTATIN","10MG","-30","Select","Select",""],["","65162055610","TEMAZEPAM","15MG","60","Select","Select",""],["","00527150237","AMPHET\/DEXTR","10MG","180","Select","Select",""],["","59267100001","PFIZER","COVID-19","0","Select","Select",""],["","00406012305","HYDROCO\/APAP","5-325MG","12","Select","Select",""],["","64380080807","IBUPROFEN","600MG","30","Select","Select",""],["","00054350049","LIDOCAINE","2% VISC","140","Select","Select",""],["","65162062711","TRAMADOL","50MG","14","Select","Select",""],["","59267100001","PFIZER ","INJ COVID-19","0","Select","Select",""],["","00527150237","AMPHET\/DEXTR ","TAB 10MG","180","Select","Select",""],["","64380080807","IBUPROFEN ","TAB 600MG","30","Select","Select",""],["","65162062711","TRAMADOL ","TAB 50MG","14","Select","Select",""],["","00054350049","LIDOCAINE ","SOL 2% VISC","140","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","",""],["No","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":""}]}]}