{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"GARLAND SIMPKINS","gend":0,"add":"1241 HEATHCLIFF DR","city":"VIRGINIA BEACH","state":"VA","zip":"23464-9998","dob":"1983-07-04","age":"","mstatus":"","insh":"1718173*01","cliId":"","pno":"757\/581-9564","cno":"757\/581-9564","email":"","ename":"","eno":"","pphy":"TANNOUS, GEORGE MD","ppno":"757\/305-1797","pcpadd":"STE 220 828 HEALTHY WAY","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23462,"pcpcounty":"","pcpid":143824,"pcpname":"BON SECOURS MEDICAL ASSOCIATES","plan":"OHP","program":"ACA","lob":"Individual","region":"TIDEWATER","aligned":"","ano":"757\/495-3904","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/309-4715","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["B20.","S86.012D","A60.00","Z28.21","Z20.828","S29.012A"],"date":["2020-10-09","2020-01-31","2020-10-08","2020-10-08","2021-05-08","2021-04-29"],"priorHcc":["","","","","",""]}},{"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":[["","15584010101","ATRIPLA","","30","Select","Select",""],["","31722077705","ACYCLOVIR","400MG","30","Select","Select",""],["","00904549213","THERA-M","","30","Select","Select",""],["","00536379001","VITAMIN","2000UNIT","90","Select","Select",""],["","00093523456","EFAVIR\/EMTRI","TENOFOVI","30","Select","Select",""],["","52817033200","CYCLOBENZAPR","10MG","15","Select","Select",""],["","67877032105","IBUPROFEN","800MG","30","Select","Select",""],["","15584010101","ATRIPLA ","","30","Select","Select",""],["","31722077705","ACYCLOVIR ","400MG","30","Select","Select",""],["","00536379001","VITAMIN ","2000UNIT","30","Select","Select",""],["","00904549213","THERA-M ","","30","Select","Select",""],["","00093523456","EFAVIR\/EMTRI ","TENOFOVI","-30","Select","Select",""],["","67877032105","IBUPROFEN ","800MG","30","Select","Select",""],["","52817033200","CYCLOBENZAPR ","10MG","15","Select","Select",""],["","80681016000","HI","BETA-CAR","30","Select","Select",""],["","80681016000","HI ","TAB BETA-CAR","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":[[["No","Select","","","","","Select","",""],["No","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":""}]}]}