{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MICHAEL   L BROWN","gend":0,"add":"42 PEBBLE POINT CT","city":"PORTSMOUTH","state":"VA","zip":"23703-9998","dob":"1971-03-01","age":"","mstatus":"","insh":"1920780*01","cliId":"","pno":"757\/606-7478","cno":"757\/606-7478","email":"","ename":"","eno":"","pphy":"PHYSICIAN, PRIMARY CARE (MISC)","ppno":"","pcpadd":"4417 CORPORATION LN","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23462,"pcpcounty":"","pcpid":799999,"pcpname":"","plan":"OHP","program":"ACA","lob":"Small Group","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":["I10.","Z94.0","E66.9","B34.9","N18.6","K75.9","E87.5","B34.8","Z86.2","E66.3","Z23.","H25.813","H35.032","Z03.89","T86.12","T86.11","H35.61","H26.9","R58.","F32.9","G40.909","D64.9","Z79.899","Z82.49","Z82.3","Z86.718","Z90.5","Z88.8","Z88.1","Z91.040","N17.9","M81.0","H25.812","Z01.818","N18.9","H25.811"],"date":["2021-08-16","2021-11-09","2020-03-06","2020-03-06","2020-03-06","2020-03-06","2021-08-16","2021-06-08","2020-06-08","2021-06-08","2021-05-05","2021-06-28","2021-06-28","2021-06-02","2021-06-02","2021-06-02","2021-06-08","2021-10-26","2021-06-02","2021-06-02","2021-06-02","2021-02-26","2021-08-16","2021-08-16","2021-08-16","2021-08-16","2021-08-16","2021-08-16","2021-08-16","2021-08-16","2021-08-16","2021-11-09","2021-10-26","2021-10-03","2021-10-03","2021-10-12"],"priorHcc":["",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":[["","68992301001","ENVARSUS ","1MG","-90","Select","Select",""],["","29300012810","HYDROCHLOROT ","25MG","90","Select","Select",""],["","00591505210","PREDNISONE ","5MG","30","Select","Select",""],["","68180098003","LISINOPRIL ","10MG","90","Select","Select",""],["","69452015120","VITAMIN ","50000UNT","-3","Select","Select",""],["","57237010201","METOPROL ","100MG","360","Select","Select",""],["","00310111030","LOKELMA ","10GM","15","Select","Select",""],["","68382000301","AZATHIOPRINE ","50MG","14","Select","Select",""],["","16729026129","MYCOPHENOLIC ","180MG DR","9","Select","Select",""],["","68992301001","ENVARSUS","1MG","-90","Select","Select",""],["","00591505210","PREDNISONE","5MG","30","Select","Select",""],["","29300012810","HYDROCHLOROT","25MG","90","Select","Select",""],["","68180098003","LISINOPRIL","10MG","90","Select","Select",""],["","69452015120","VITAMIN","50000UNT","-3","Select","Select",""],["","57237010201","METOPROL","100MG","360","Select","Select",""],["","00310111030","LOKELMA","10GM","15","Select","Select",""],["","16729026129","MYCOPHENOLIC","180MG DR","9","Select","Select",""],["","68382000301","AZATHIOPRINE","50MG","14","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":""}]}]}