{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"STEVEN   A ODEHNAL","gend":0,"add":"2100 MARINA SHORES DR APT 5","city":"VIRGINIA BEACH","state":"VA","zip":"23451-9998","dob":"1961-10-24","age":"","mstatus":"","insh":"1584877*01","cliId":"","pno":"703\/972-9128","cno":"703\/972-9128","email":"","ename":"","eno":"","pphy":"BICE, HAMILTON L DO","ppno":"757\/395-6630","pcpadd":"STE 200 1080 FIRST COLONIAL RD","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23454,"pcpcounty":"","pcpid":117381,"pcpname":"Cape Charles Medical Center","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":["R55.","I51.7","R97.20","E78.2","I10.","I47.1","F41.9","I77.810","H40.1111","H40.1121","Z72.0","H40.1131","Z23.","F17.208","F17.210","Z91.030","R73.9","Z12.11"],"date":["2020-01-13","2020-01-13","2021-09-22","2021-09-22","2021-09-22","2021-09-22","2021-09-22","2021-09-22","2020-01-21","2020-01-28","2020-03-10","2020-09-17","2021-09-22","2020-09-21","2021-09-22","2021-09-22","2021-09-22","2021-08-30"],"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":[["","62332020930","TELMISA\/HCTZ ","40-12.5","90","Select","Select",""],["","27808015601","ROSUVASTATIN ","10MG","90","Select","Select",""],["","65862001230","SERTRALINE ","50MG","90","Select","Select",""],["","50742061501","METOPROL ","25MG ER","90","Select","Select",""],["","68180051901","LISINOP\/HCTZ ","20-12.5","-90","Select","Select",""],["","68180021609","LOSARTAN\/HCT ","100-12.5","30","Select","Select",""],["","65862001230","SERTRALINE","50MG","90","Select","Select",""],["","27808015601","ROSUVASTATIN","10MG","90","Select","Select",""],["","62332020930","TELMISA\/HCTZ","40-12.5","90","Select","Select",""],["","68180051901","LISINOP\/HCTZ","20-12.5","-90","Select","Select",""],["","50742061501","METOPROL","25MG ER","90","Select","Select",""],["","68180021609","LOSARTAN\/HCT","100-12.5","30","Select","Select",""],["","57237002801","AMOXICILLIN","500MG","21","Select","Select",""],["","00093598627","EPINEPHRINE","0.3MG","2","Select","Select",""],["","57237002801","AMOXICILLIN ","TAB 500MG","21","Select","Select",""],["","00093598627","EPINEPHRINE ","INJ 0.3MG","2","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":""}]}]}