{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ANDREW   MICHAEL CATHERINES","gend":0,"add":"722 HUNTERS BRIDGE DR","city":"CHESAPEAKE","state":"VA","zip":"23320-9998","dob":"1990-03-15","age":"","mstatus":"","insh":"2018604*01","cliId":"","pno":"757\/343-8022","cno":"757\/343-8022","email":"","ename":"","eno":"","pphy":"TAN-GONZALES, DESIREE MD","ppno":"757\/548-0076","pcpadd":"725 VOLVO PKWY SUITE 100","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":23320,"pcpcounty":"","pcpid":129852,"pcpname":"Volvo Medical Associates","plan":"OHP","program":"ACA","lob":"Individual","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/548-1652","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F41.1","F33.1","F31.9"],"date":["2021-11-04","2021-11-04","2020-06-30"],"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":[["","57237001930","DULOXETINE","60MG","30","Select","Select",""],["","67877022210","GABAPENTIN","100MG","30","Select","Select",""],["","68180045001","QUETIAPINE","400MG","30","Select","Select",""],["","13107003134","MIRTAZAPINE","15MG","60","Select","Select",""],["","16714061305","SERTRALINE","100MG","30","Select","Select",""],["","00093005301","BUSPIRONE","5MG","120","Select","Select",""],["","68382080601","TRAZODONE","100MG","90","Select","Select",""],["","29300013501","CLONIDINE","0.1MG","30","Select","Select",""],["","43547028211","ESCITALOPRAM","20MG","30","Select","Select",""],["","80777027398","MODERNA","COVID-19","0","Select","Select",""],["","43598075205","BUPROPION","150MG SR","60","Select","Select",""],["","68382009716","PAROXETINE","10MG","30","Select","Select",""],["","67877022210","GABAPENTIN ","100MG","30","Select","Select",""],["","57237001930","DULOXETINE ","60MG","60","Select","Select",""],["","68180045001","QUETIAPINE ","400MG","30","Select","Select",""],["","68382080701","TRAZODONE ","150MG","30","Select","Select",""],["","13107003134","MIRTAZAPINE ","15MG","-60","Select","Select",""],["","16714061305","SERTRALINE ","100MG","30","Select","Select",""],["","00093005301","BUSPIRONE ","5MG","120","Select","Select",""],["","29300013501","CLONIDINE ","0.1MG","30","Select","Select",""],["","68382009716","PAROXETINE ","10MG","30","Select","Select",""],["","43547028111","ESCITALOPRAM ","10MG","30","Select","Select",""],["","43598075205","BUPROPION ","150MG SR","30","Select","Select",""],["","80777027399","MODERNA ","COVID-19","0","Select","Select",""],["","00228202750","ALPRAZOLAM ","0.25MG","30","Select","Select",""],["","00228202750","ALPRAZOLAM","0.25MG","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","",""],["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":""}]}]}