{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"AARON   B HELLMAN","gend":0,"add":"932 WILDFLOWER CT","city":"VIRGINIA BEACH","state":"VA","zip":"23452-9998","dob":"1981-02-15","age":"","mstatus":"","insh":"1757283*01","cliId":"","pno":"757\/359-5923","cno":"757\/359-5923","email":"","ename":"","eno":"","pphy":"VACCARELLA, JOSEPH E MD","ppno":"757\/842-6180","pcpadd":"STE 101 1419 CEDAR ROAD","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":23322,"pcpcounty":"","pcpid":146583,"pcpname":"Cedar Road Medical Associates","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"757\/359-9683","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/842-6181","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E55.9","E78.5","E29.1","Z11.52","Z30.09"],"date":["2021-05-11","2021-10-13","2021-10-13","2021-04-13","2021-10-13"],"priorHcc":["",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":[["","00310737220","BUDES\/FORMOT","80-4.5","10","Select","Select",""],["","00173071520","ADVAIR","45\/21","-12","Select","Select",""],["","52536062501","TESTOST","200MG\/ML","4","Select","Select",""],["","00186037220","SYMBICORT","80-4.5","-10","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","00093317431","ALBUTEROL","HFA","8","Select","Select",""],["","00173071520","ADVAIR ","45\/21","-12","Select","Select",""],["","00186037220","SYMBICORT ","80-4.5","-10","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","00093317431","ALBUTEROL ","HFA","8","Select","Select",""],["","00310737220","BUDES\/FORMOT ","80-4.5","10","Select","Select",""],["","52536062501","TESTOST ","200MG\/ML","10","Select","Select",""],["","59267100003","PFIZER ","COVID-19","0","Select","Select",""],["","59267100003","PFIZER","COVID-19","0","Select","Select",""],["","00173068220","VENTOLIN","","18","Select","Select",""],["","31722070290","LOSARTAN","100MG","-30","Select","Select",""],["","00173068220","VENTOLIN ","AER ","18","Select","Select",""],["","31722070290","LOSARTAN ","TAB 100MG","-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":""}]}]}