{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"NATHANIEL   JARRETT WEBB III","gend":0,"add":"708 THIMBLE SHOALS BLVD # STE C","city":"NEWPORT NEWS","state":"VA","zip":"23606-9998","dob":"1957-11-19","age":"","mstatus":"","insh":"1805636*01","cliId":"","pno":"757\/722-6015","cno":"757\/722-6015","email":"","ename":"","eno":"","pphy":"KRAMER, DAVID T MD","ppno":"757\/968-5700","pcpadd":"2855 DENBIGH BOULEVARD","pcpcity":"GRAFTON","pcpstate":"VA","pcpzip":23692,"pcpcounty":"","pcpid":118380,"pcpname":"Patriot Primary Care","plan":"OHP","program":"ACA","lob":"Individual","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/968-5717","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E11.9","H25.13","H04.123","Z23.","D48.5","L30.0","D23.9","I78.1","L73.8","D22.9","L82.1","L81.4","Z12.83","Z71.9","S60.413A","I11.0","I50.9","I25.10","Z79.01","Z79.84","Z79.899","S61.432A","R93.89","N43.40","S69.92XA","I48.21","E78.2","I10.","E55.9","D64.9","E03.9","J40.","Z12.11","K59.00","E11.42","I48.0","Z98.890","Z12.5","R79.89","M79.10","E78.1","Z00.00","J30.2"],"date":["2021-09-22","2021-06-04","2021-06-04","2021-09-21","2020-04-28","2020-04-28","2020-04-28","2020-04-28","2020-04-28","2020-04-28","2020-04-28","2020-04-28","2020-04-28","2020-04-28","2020-12-10","2020-12-10","2020-12-10","2020-12-10","2021-06-28","2020-12-10","2020-12-10","2020-12-10","2020-02-06","2020-02-06","2020-12-09","2021-09-22","2021-09-22","2021-09-21","2021-09-22","2020-12-18","2020-12-18","2020-11-14","2021-05-23","2020-12-03","2020-04-06","2020-04-06","2020-06-22","2021-09-22","2021-11-01","2021-11-01","2021-11-01","2021-09-21","2021-09-21"],"priorHcc":[null,"","",null,"","","","","","","","","","","","","","","","","","","","","",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":[["","69315011610","FUROSEMIDE","20MG","30","Select","Select",""],["","60631004030","EDARBI","40MG","90","Select","Select",""],["","68462019690","PRAVASTATIN","20MG","30","Select","Select",""],["","69097094307","GABAPENTIN","300MG","-180","Select","Select",""],["","00003089421","ELIQUIS","5MG","60","Select","Select",""],["","65862000899","METFORMIN","500MG","-60","Select","Select",""],["","62037059790","CARTIA","120\/24HR","30","Select","Select",""],["","10370082911","DILTIAZEM","120MG ER","30","Select","Select",""],["","00536105224","PEG3350","","238","Select","Select",""],["","53885026701","ONETOUCH","VERIO IQ","1","Select","Select",""],["","68180012201","CEPHALEXIN","500MG","-20","Select","Select",""],["","00603533831","PREDNISONE","10MG","48","Select","Select",""],["","53885004401","ONE","VERIO FL","-1","Select","Select",""],["","51672138602","FLUOCINONIDE","0.05%","30","Select","Select",""],["","67877057305","BENZONATATE","100MG","15","Select","Select",""],["","00132070336","FLEET","10\/30ML","37","Select","Select",""],["","69238110005","DOXYCYCL","100MG","20","Select","Select",""],["","60631004030","EDARBI ","40MG","30","Select","Select",""],["","68462019690","PRAVASTATIN ","20MG","30","Select","Select",""],["","69097094307","GABAPENTIN ","300MG","-180","Select","Select",""],["","69315011610","FUROSEMIDE ","20MG","30","Select","Select",""],["","65862000899","METFORMIN ","500MG","60","Select","Select",""],["","62037059790","CARTIA ","120\/24HR","30","Select","Select",""],["","00003089421","ELIQUIS ","5MG","60","Select","Select",""],["","10370082911","DILTIAZEM ","120MG ER","30","Select","Select",""],["","51672138602","FLUOCINONIDE ","0.05%","30","Select","Select",""],["","00536105224","PEG3350 ","","-238","Select","Select",""],["","00132070336","FLEET ","10\/30ML","37","Select","Select",""],["","69238110005","DOXYCYCL ","100MG","20","Select","Select",""],["","00603533831","PREDNISONE ","10MG","48","Select","Select",""],["","68180012202","CEPHALEXIN ","500MG","20","Select","Select",""],["","53885026701","ONETOUCH ","VERIO IQ","-1","Select","Select",""],["","53885004401","ONE ","VERIO FL","-1","Select","Select",""],["","67877057305","BENZONATATE ","100MG","15","Select","Select",""],["","68645056054","MONTELUKAST","10MG","-30","Select","Select",""],["","43598091090","FENOFIBRATE","160MG","30","Select","Select",""],["","68645056054","MONTELUKAST ","TAB 10MG","-30","Select","Select",""],["","27241011703","FENOFIBRATE ","TAB 160MG","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":""}]}]}