{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"EARL   GLENN HOLLAND","gend":0,"add":"114 BRADLEY DR","city":"YORKTOWN","state":"VA","zip":"23692-9998","dob":"1956-12-22","age":"","mstatus":"","insh":"2016413*01","cliId":"","pno":"757\/898-1575","cno":"757\/898-1575","email":"","ename":"","eno":"","pphy":"GUAN, YU MD","ppno":"757\/898-7261","pcpadd":"307 COOK ROAD","pcpcity":"YORKTOWN","pcpstate":"VA","pcpzip":23692,"pcpcounty":"","pcpid":157501,"pcpname":"YORKTOWN FAMILY MEDICINE","plan":"OHP","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":["H25.813","Z83.518","I25.10","I10.","R73.03","E53.8","E55.9","Z12.11","Z23.","E03.9","E78.5","Z82.49","E78.00","R10.9"],"date":["2020-12-21","2020-12-21","2021-02-01","2021-06-21","2021-06-21","2021-06-21","2021-06-21","2021-05-23","2021-11-19","2020-12-21","2021-01-19","2021-01-19","2021-06-21","2021-10-22"],"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":[["","43547035410","LISINOPRIL","20MG","30","Select","Select",""],["","68180096601","LEVOTHYROXIN","50MCG","30","Select","Select",""],["","31722070190","LOSARTAN","50MG","90","Select","Select",""],["","27808015701","ROSUVASTATIN","20MG","30","Select","Select",""],["","68180096601","LEVOTHYROXIN ","50MCG","30","Select","Select",""],["","43547035410","LISINOPRIL ","20MG","30","Select","Select",""],["","31722070190","LOSARTAN ","50MG","90","Select","Select",""],["","27808015701","ROSUVASTATIN ","20MG","30","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":""}]}]}