{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" MICHAEL L MOUNGER","gend":0,"add":"1027 WINWARD ROAD","city":"NORFOLK","state":"VA","zip":"23513-9998","dob":"1958-03-05","age":"","mstatus":"","insh":"1873077*01","cliId":"","pno":"757\/323-9102","cno":"757\/323-9102, 757\/323-9102, ","email":"","ename":"","eno":"","pphy":"FEE, ERIC MD","ppno":"757\/587-0157","pcpadd":"7924 CHESAPEAKE BLVD","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":"23518-9998","pcpcounty":"","pcpid":670139,"pcpname":"Bayview Medical Center","plan":"OHP - OPTIMA","program":"ACA","lob":"Individual","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K22.8","K22.70","R93.3","K44.9","M48.02","C76.0","M54.5","M79.604","G89.29","K56.2","K55.9","E87.1","Z68.1","K56.7","Q43.0","Z92.21","Z20.828","Z92.3","Z85.01","K66.0","K12.33","Z79.891","K76.0","D72.829","E87.6","D64.9","G89.4","M54.16","M48.062","M51.26","Z71.3","Z23.","F17.210","J86.9","A41.9","J18.9","J90.","E83.42","C15.9","R91.8","A42.9","A49.01","J43.9","Z46.82","J96.01","J94.8","R74.01","Z78.9","R52.","J98.11","J18.1","K04.7","J32.0","K12.2","J81.1","E44.0","I10.","R53.81","R07.9","K59.8","K59.39","N28.1","R13.10","M47.12","M51.36","R10.84","R06.02","C12.","R13.13","K21.9","R10.13","M50.30","M50.23","M47.812","Z09.","F32.9","M43.12","M85.88","J38.6","K63.89","Z98.890","Z79.899","E78.5","Z12.5","Z92.29","Z90.49","R63.8","J98.2","C77.9","M89.9","M50.21","M50.31","F41.9","Z88.8","Z85.828","Z85.818","M50.323","M50.321","M51.17","S22.42XD","K57.10"],"date":["2020-04-20","2020-04-20","2020-04-20","2020-04-20","2021-04-22","2021-04-28","2020-06-15","2020-05-14","2020-06-15","2020-06-15","2020-06-08","2021-05-15","2020-06-08","2021-05-03","2020-06-08","2020-12-28","2020-06-08","2020-12-28","2020-06-08","2020-06-08","2020-06-13","2020-06-08","2020-06-08","2020-06-08","2021-06-08","2020-12-21","2021-03-29","2021-04-22","2021-04-13","2021-03-29","2021-02-25","2021-04-21","2021-03-29","2021-06-08","2021-06-08","2021-06-08","2021-06-08","2021-05-03","2021-05-20","2021-06-02","2021-06-04","2021-06-04","2021-05-19","2021-06-02","2021-05-20","2021-06-08","2021-06-08","2021-06-08","2021-06-08","2021-05-27","2021-05-28","2021-05-05","2021-05-05","2021-05-05","2021-05-08","2021-05-15","2021-05-15","2021-05-15","2021-05-23","2020-06-08","2020-06-08","2020-06-08","2021-04-29","2021-04-22","2021-04-22","2021-04-28","2021-04-28","2021-01-21","2020-03-20","2020-04-20","2020-03-20","2020-04-04","2020-04-04","2020-04-04","2020-06-26","2021-05-22","2020-02-01","2020-02-01","2020-02-01","2020-06-12","2020-12-28","2021-02-25","2020-12-21","2020-12-21","2021-04-21","2020-06-12","2021-05-01","2021-05-11","2020-01-03","2020-12-28","2020-04-04","2021-04-13","2020-04-20","2020-04-20","2020-04-20","2021-02-08","2021-04-13","2021-04-13","2021-04-13","2021-04-27","2020-06-08"],"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":[["","68180072103","AMLODIPINE","10MG","-30","Select","Select",""],["","65862029490","ROSUVASTATIN","10MG","30","Select","Select",""],["","00406052301","OXYCOD\/APAP","10-325MG","120","Select","Select",""],["","00536100901","FERROUS","325MG","30","Select","Select",""],["","00904759080","FEROSUL","325MG","30","Select","Select",""],["","55111015901","OMEPRAZOLE","40MG","30","Select","Select",""],["","00143924920","AMOX\/K","875-125","26","Select","Select",""],["","69547035302","NARCAN","","2","Select","Select",""],["","31722095801","BENZONATATE","200MG","-30","Select","Select",""],["","50228018001","GABAPENTIN","300MG","90","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","",""],["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":""}]}]}