{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JOEY   A GARBE","gend":0,"add":"613 IRIS LN","city":"VIRGINIA BEACH","state":"VA","zip":"23462-9998","dob":"1971-01-13","age":"","mstatus":"","insh":"1865985*01","cliId":"","pno":"757\/275-5803","cno":"757\/275-5803","email":"","ename":"","eno":"","pphy":"SINGSON, FLORISA S MD","ppno":"757\/518-8810","pcpadd":"STE B 4501 N WITCHDUCK RD","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23455,"pcpcounty":"","pcpid":132034,"pcpname":"","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/518-8825","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E11.65","E11.49","Z79.4","E11.3411","E11.3412","E11.40","K21.9","H35.00","G62.9","I10.","E78.2","E11.3413","G47.33","H25.11","L02.11","Z72.0","L02.91","E11.9","K05.219","S93.402A","H25.12","Z20.828","R50.9","R05.","F17.200","Z91.013"],"date":["2021-07-23","2020-08-17","2021-07-23","2021-07-15","2021-07-15","2021-07-23","2021-07-23","2021-07-23","2021-07-23","2021-07-23","2021-07-23","2020-01-29","2021-05-21","2021-05-21","2020-06-23","2020-06-23","2020-06-30","2020-06-30","2020-08-17","2020-06-09","2020-07-16","2020-10-05","2020-10-05","2020-10-05","2020-06-23","2020-06-23"],"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":[["","00597015330","JARDIANCE ","25MG","30","Select","Select",""],["","00088221905","LANTUS ","100\/ML","30","Select","Select",""],["","00002879959","HUMALOG ","100\/ML","15","Select","Select",""],["","00378668977","PANTOPRAZOLE ","40MG","90","Select","Select",""],["","65862042005","SMZ\/TMP ","800-160","14","Select","Select",""],["","08290320547","BD  PEN NEEDL","32GX4MM","-100","Select","Select",""],["","64380080707","IBUPROFEN ","800MG","21","Select","Select",""],["","00002771559","BASAGLAR ","100UNIT","15","Select","Select",""],["","00116200116","CHLORHEX ","0.12%","473","Select","Select",""],["","65862018601","CLINDAMYCIN ","300MG","30","Select","Select",""],["","64980051401","TIMOLOL ","0.5% OP","-10","Select","Select",""],["","68180051303","LISINOPRIL ","5MG","90","Select","Select",""],["","64380071206","BENZONATATE ","100MG","-30","Select","Select",""],["","57237007710","ONDANSETRON ","4MG ODT","10","Select","Select",""],["","00002822259","INSULIN ","100\/ML","75","Select","Select",""],["","55111012305","ATORVASTATIN ","40MG","90","Select","Select",""],["","00002143380","TRULICITY ","0.75\/0.5","2","Select","Select",""],["","00597015330","JARDIANCE","25MG","30","Select","Select",""],["","00088221905","LANTUS","100\/ML","-30","Select","Select",""],["","00002879959","HUMALOG","100\/ML","15","Select","Select",""],["","65862056090","PANTOPRAZOLE","40MG","90","Select","Select",""],["","65862042005","SMZ\/TMP","800-160","14","Select","Select",""],["","08290320547","BD PEN NEEDL","32GX4MM","-200","Select","Select",""],["","00116200116","CHLORHEX","0.12%","473","Select","Select",""],["","64380080707","IBUPROFEN","800MG","21","Select","Select",""],["","00002771559","BASAGLAR","100UNIT","15","Select","Select",""],["","65862018601","CLINDAMYCIN","300MG","-30","Select","Select",""],["","68180051303","LISINOPRIL","5MG","90","Select","Select",""],["","64380071206","BENZONATATE","100MG","-30","Select","Select",""],["","57237007710","ONDANSETRON","4MG ODT","10","Select","Select",""],["","64980051401","TIMOLOL","0.5% OP","10","Select","Select",""],["","00002822259","INSULIN","100\/ML","75","Select","Select",""],["","55111012305","ATORVASTATIN","40MG","90","Select","Select",""],["","00002143380","TRULICITY","0.75\/0.5","-2","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":""}]}]}