{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KENNETH SAWYER","gend":0,"add":"7621 LANKFORD AVE","city":"NORFOLK","state":"VA","zip":"23505-9998","dob":"1963-03-19","age":"","mstatus":"","insh":"1909584*01","cliId":"","pno":"757\/617-1832","cno":"757\/617-1832","email":"","ename":"","eno":"","pphy":"DONALDSON, NICOLE MD","ppno":"757\/227-6866","pcpadd":"SUITE 504 301 RIVERVIEW AVENUE","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23510,"pcpcounty":"","pcpid":161071,"pcpname":"Fort Norfolk Plaza Primary Care","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"757\/543-5893","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/277-0298","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K21.9","I25.10","R00.1","F17.210","Z86.711","Z79.01","Z79.899","Z80.1","Z82.49","Z91.19","Z88.5","R07.89","R07.9","F17.200","I26.99","E78.5","G47.33","Z12.11","G47.00","R10.9","D18.03","K04.7","I20.8","I51.7","R01.1","R06.02","I77.810","L27.1","K92.1","R94.31","I73.9","R06.89","F51.01","R03.0","E78.00","J43.9","M71.50"],"date":["2020-01-24","2020-01-27","2020-01-24","2020-01-27","2020-01-27","2021-03-11","2020-01-24","2020-01-24","2020-01-24","2020-01-24","2020-01-24","2020-01-26","2020-01-27","2021-08-06","2021-03-11","2020-08-28","2021-10-27","2021-08-30","2021-08-06","2021-04-23","2021-04-23","2020-05-12","2021-03-11","2021-03-11","2021-03-11","2020-08-18","2020-01-24","2021-04-15","2021-04-15","2021-03-11","2021-03-11","2021-03-11","2021-03-11","2021-03-11","2021-03-11","2020-01-24","2021-07-26"],"priorHcc":["","","","","","","","","","","","","","","","",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":[["","50458057930","XARELTO","20MG","30","Select","Select",""],["","67877022005","CEPHALEXIN","250MG","40","Select","Select",""],["","42571016242","AMOX\/K","875-125","-20","Select","Select",""],["","00054327099","FLUTICASONE","50MCG","48","Select","Select",""],["","13668000701","ZOLPIDEM","5MG","5","Select","Select",""],["","55111012205","ATORVASTATIN","20MG","90","Select","Select",""],["","51672128402","TRIAMCINOLON","0.10%","90","Select","Select",""],["","50458057930","XARELTO ","20MG","30","Select","Select",""],["","67877022005","CEPHALEXIN ","250MG","40","Select","Select",""],["","42571016242","AMOX\/K ","875-125","20","Select","Select",""],["","60505082901","FLUTICASONE ","50MCG","-48","Select","Select",""],["","13668000701","ZOLPIDEM ","5MG","-5","Select","Select",""],["","55111012205","ATORVASTATIN ","20MG","-30","Select","Select",""],["","51672128402","TRIAMCINOLON ","0.10%","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":""}]}]}