{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CHRIS   J WIEGMANN","gend":0,"add":"501 CORNICK RD","city":"PORTSMOUTH","state":"VA","zip":"23701-9998","dob":"1965-07-08","age":"","mstatus":"","insh":"1632083*02","cliId":"","pno":"757\/876-9554","cno":"757\/876-8554","email":"","ename":"","eno":"","pphy":"ANGLIN, VICTOR TEODORO MD","ppno":"757\/738-1225","pcpadd":"3537 AIRLINE BLVD STE 1","pcpcity":"PORTSMOUTH","pcpstate":"VA","pcpzip":23701,"pcpcounty":"","pcpid":207840,"pcpname":"AIRLINE BOULEVARD MEDICAL ASSOCIATES","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"516\/712-7737","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/448-1037","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G47.33","M47.896","G89.4","M54.16","M48.061","M48.07","M51.26","M43.16","M47.817","U07.1","Z12.11"],"date":["2021-06-19","2021-09-09","2021-09-09","2021-09-09","2021-09-09","2021-09-09","2021-09-09","2021-09-09","2021-09-09","2021-09-26","2021-08-30"],"priorHcc":["",null,null,null,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":[["","75987001003","DUEXIS","800-26.6","90","Select","Select",""],["","27241009903","DULOXETINE","60MG","90","Select","Select",""],["","65862059801","TAMSULOSIN","0.4MG","90","Select","Select",""],["","75987001003","DUEXIS ","800-26.6","90","Select","Select",""],["","65862059801","TAMSULOSIN ","0.4MG","90","Select","Select",""],["","27241009903","DULOXETINE ","60MG","90","Select","Select",""],["","70010077001","METHOCARBAM ","750MG","30","Select","Select",""],["","00172392660","DIAZEPAM ","5MG","3","Select","Select",""],["","00603188016","LIDOCAINE ","5%","30","Select","Select",""],["","00603188016","LIDOCAINE","5%","-30","Select","Select",""],["","70010077001","METHOCARBAM","750MG","30","Select","Select",""],["","00172392660","DIAZEPAM","5MG","4","Select","Select",""],["","67877062690","IBU\/FAMOT ","TAB 800-26.6","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":[[["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":""}]}]}