{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CARLO   J ABBRUZZO","gend":0,"add":"1612 BOHNHOFF DR","city":"VIRGINIA BEACH","state":"VA","zip":"23454-9998","dob":"1958-08-21","age":"","mstatus":"","insh":"1578650*01","cliId":"","pno":"757\/572-3456","cno":"757\/572-3456","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":"757\/572-3456","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":["F90.0","F10.20","F33.9","F95.2","Z12.11","F12.10","F32.9","Z79.899","I10.","E78.5","R73.03","N52.9","F33.2","F43.21","F90.9","F42.9","F41.9","G47.30","Z88.8","F10.929","F10.94","Z11.59","Z12.5"],"date":["2021-11-03","2021-11-03","2021-11-03","2021-11-03","2021-06-21","2021-04-01","2021-03-25","2021-04-01","2021-04-01","2021-10-25","2021-10-25","2021-02-24","2021-04-01","2021-04-01","2021-04-01","2021-04-01","2021-04-01","2021-04-01","2021-04-01","2021-03-13","2021-03-12","2021-08-11","2021-10-25"],"priorHcc":[null,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":[["","10147068601","METHYLPHENID","36MG ER","60","Select","Select",""],["","23155019101","BUPROPION","75MG","30","Select","Select",""],["","65162071310","GUANFACINE","2MG","-90","Select","Select",""],["","65862001330","SERTRALINE","100MG","180","Select","Select",""],["","67877019905","AMLODIPINE","10MG","90","Select","Select",""],["","50742061501","METOPROL","25MG ER","90","Select","Select",""],["","69238115403","EZETIMIBE","10MG","90","Select","Select",""],["","00185014601","NABUMETONE","750MG","60","Select","Select",""],["","70748013306","SILDENAFIL","100MG","5","Select","Select",""],["","42571017390","ATORVASTATIN","20MG","90","Select","Select",""],["","65162025009","CHLORTHALID","50MG","180","Select","Select",""],["","50458058601","CONCERTA","36MG","60","Select","Select",""],["","00185014601","NABUMETONE ","750MG","60","Select","Select",""],["","65162071310","GUANFACINE ","2MG","30","Select","Select",""],["","42571017390","ATORVASTATIN ","20MG","90","Select","Select",""],["","10147068601","METHYLPHENID ","36MG ER","60","Select","Select",""],["","65162025009","CHLORTHALID ","50MG","180","Select","Select",""],["","65862001330","SERTRALINE ","100MG","60","Select","Select",""],["","50742061501","METOPROL ","25MG ER","90","Select","Select",""],["","23155019101","BUPROPION ","75MG","30","Select","Select",""],["","70748013306","SILDENAFIL ","100MG","5","Select","Select",""],["","67877019905","AMLODIPINE ","10MG","90","Select","Select",""],["","69238115403","EZETIMIBE ","10MG","90","Select","Select",""],["","50458058601","CONCERTA ","36MG","60","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":""}]}]}