{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KAREN   F DAVIS","gend":1,"add":"1114 CENTRE AVE","city":"PORTSMOUTH","state":"VA","zip":"23704-9998","dob":"1962-01-17","age":"","mstatus":"","insh":"1707728*01","cliId":"","pno":"757\/399-6366","cno":"757\/399-6366","email":"","ename":"","eno":"","pphy":"HUNTE, NOEL MD","ppno":"757\/465-8450","pcpadd":"4020 RAINTREE RD #B","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":23321,"pcpcounty":"","pcpid":540568,"pcpname":"INTERNISTS OF CHURCHLAND","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"757\/971-3242","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/465-8616","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E11.9","H25.13","E11.8","I10.","E55.9","M10.9","Z12.11"],"date":["2020-12-07","2020-12-07","2020-12-29","2020-12-29","2020-12-29","2020-12-29","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":[["","62332013230","OLMESA","20MG","30","Select","Select",""],["","00006027731","JANUVIA","100MG","90","Select","Select",""],["","29300012810","HYDROCHLOROT","25MG","90","Select","Select",""],["","00378108601","COLCHICINE","0.6MG","-10","Select","Select",""],["","60429011318","METFORMIN","1000MG","180","Select","Select",""],["","53746051105","SPIRONOLACT","25MG","30","Select","Select",""],["","99073013001","FREESTYLE MIS LANCETS","LANCETS","100","Select","Select",""],["","62332013230","OLMESA ","20MG","30","Select","Select",""],["","00006027731","JANUVIA ","100MG","90","Select","Select",""],["","29300012810","HYDROCHLOROT ","25MG","90","Select","Select",""],["","00378108601","COLCHICINE ","0.6MG","-10","Select","Select",""],["","99073013001","FREESTYLE    MIS LANCETS","LANCETS","100","Select","Select",""],["","60429011318","METFORMIN ","1000MG","180","Select","Select",""],["","53746051105","SPIRONOLACT ","25MG","30","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","",""],["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":""}]}]}