{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ALEXIS   JOEL CURRIE","gend":0,"add":"3217 DEER PARK DR","city":"VIRGINIA BEACH","state":"VA","zip":"23452-9998","dob":"1984-05-07","age":"","mstatus":"","insh":"1878995*01","cliId":"","pno":"757\/869-8916","cno":"757\/869-8916","email":"","ename":"","eno":"","pphy":"WELLS, VIRGINIA MD","ppno":"757\/222-0300","pcpadd":"2900 SABRE ST STE 300","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23452,"pcpcounty":"","pcpid":190887,"pcpname":"","plan":"OHP","program":"ACA","lob":"Individual","region":"TIDEWATER","aligned":"","ano":"757\/869-8919","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":["G62.9","M35.00","Z87.891","I10.","E55.9","E78.5","R10.13","F41.9","K31.89","K31.7","K44.9","R53.83","R79.82","Z20.828","D89.9","H18.603","R10.9","R94.5","Z79.899","M79.10","M54.12","R07.9","R00.0","K76.0"],"date":["2021-05-21","2021-05-21","2021-04-12","2020-09-22","2020-10-16","2020-10-16","2021-06-15","2021-05-27","2021-06-15","2021-06-15","2021-06-15","2020-09-22","2020-09-22","2020-08-26","2020-03-30","2020-03-30","2021-04-16","2020-06-15","2020-02-14","2020-02-14","2020-02-14","2020-09-22","2020-09-22","2021-06-03"],"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":[["","00115351101","PYRIDOSTIGM","60MG","60","Select","Select",""],["","00228202950","ALPRAZOLAM","0.5MG","30","Select","Select",""],["","69452015120","VITAMIN","50000UNT","-12","Select","Select",""],["","59651000305","OMEPRAZOLE","40MG","90","Select","Select",""],["","50428317699","CVS","125MG","18","Select","Select",""],["","59267100001","PFIZER","COVID-19","0","Select","Select",""],["","31722057330","ESOMEPRA","40MG DR","90","Select","Select",""],["","00115351101","PYRIDOSTIGM ","60MG","-60","Select","Select",""],["","00228202950","ALPRAZOLAM ","0.5MG","30","Select","Select",""],["","69452015120","VITAMIN ","50000UNT","4","Select","Select",""],["","50428317699","CVS ","125MG","18","Select","Select",""],["","59651000305","OMEPRAZOLE ","40MG","90","Select","Select",""],["","59267100001","PFIZER ","COVID-19","0","Select","Select",""],["","31722057330","ESOMEPRA ","40MG DR","90","Select","Select",""],["","62175061743","PANTOPRAZOLE ","40MG","-180","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":""}]}]}