{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ROGER   WAYNE FRYE JR","gend":0,"add":"1539 GROVE ST","city":"HAMPTON","state":"VA","zip":"23664-9998","dob":"1973-08-03","age":"","mstatus":"","insh":"1694423*01","cliId":"","pno":"757\/725-1366","cno":"757\/725-1366","email":"","ename":"","eno":"","pphy":"ARNOLD, HELEN G DO","ppno":"757\/850-1311","pcpadd":"12715 WARWICK BLVD STE O","pcpcity":"NEWPORT NEWS","pcpstate":"VA","pcpzip":23606,"pcpcounty":"","pcpid":118380,"pcpname":"Commonwealth Family Practice","plan":"OHP","program":"ACA","lob":"Individual","region":"TIDEWATER","aligned":"","ano":"757\/725-1366","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/269-4406","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["L97.524","Z01.818","E11.40","S91.332D","M86.672","R60.0","M20.42","M20.41","L84.","B35.1","E78.2","L03.032","L02.612","Z98.890","E78.6","Z78.9","Z83.3","L03.116","E11.52","I96.","E11.621","B95.7","Z79.4","Z28.21","E11.69","E11.49","S91.332A","R05.","E08.01","M20.5X2","Z23.","R03.0","E78.5","Z12.11","Z12.12"],"date":["2020-05-01","2020-01-21","2021-10-19","2020-05-22","2020-05-01","2020-05-22","2020-11-20","2020-11-20","2020-10-14","2020-10-14","2021-02-18","2020-01-24","2020-01-24","2020-01-22","2021-10-19","2021-10-19","2021-10-19","2020-01-21","2020-01-21","2020-01-21","2020-01-21","2020-01-21","2020-01-22","2020-01-21","2021-10-19","2020-10-14","2020-01-20","2020-01-30","2020-01-21","2020-11-20","2020-01-21","2021-10-19","2021-10-19","2021-10-19","2021-10-19"],"priorHcc":["","",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":[["","42385090210","METFORMIN","1000MG","60","Select","Select",""],["","16714089501","GLIPIZIDE","5MG","60","Select","Select",""],["","00406012301","HYDROCO\/APAP","5-325MG","16","Select","Select",""],["","65862007701","CIPROFLOXACN","500MG","28","Select","Select",""],["","63304069301","CLINDAMYCIN","300MG","42","Select","Select",""],["","69452014320","BENZONATATE","100MG","30","Select","Select",""],["","67877041984","LINEZOLID","600MG","-60","Select","Select",""],["","57896086905","PROBIOTIC","250MG","60","Select","Select",""],["","59651005290","EZETIMIBE","10MG","30","Select","Select",""],["","65862088901","GLIPIZIDE ","5MG","-60","Select","Select",""],["","23155010205","METFORMIN ","500MG","90","Select","Select",""],["","31722074920","LINEZOLID ","600MG","20","Select","Select",""],["","65862007701","CIPROFLOXACN ","500MG","28","Select","Select",""],["","63304069301","CLINDAMYCIN ","300MG","42","Select","Select",""],["","00406012301","HYDROCO\/APAP ","5-325MG","16","Select","Select",""],["","69452014320","BENZONATATE ","100MG","30","Select","Select",""],["","57896086905","PROBIOTIC ","250MG","60","Select","Select",""],["","68382077316","EZETIMIBE ","10MG","-30","Select","Select",""],["","57599000101","FREESTYLE KIT SENSOR","SENSOR","1","Select","Select",""],["","57599000200","FREESTYLE MIS READER","READER","1","Select","Select",""],["","57599000200","FREESTYLE    MIS READER","MIS READER","1","Select","Select",""],["","57599000101","FREESTYLE    KIT SENSOR","KIT SENSOR","1","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","",""],["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":""}]}]}