{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JERRY ELLIS JR","gend":0,"add":"1055 TIVOLI CRES APT 204","city":"VIRGINIA BEACH","state":"VA","zip":"23453-9998","dob":"1986-10-22","age":"","mstatus":"","insh":"2020940*01","cliId":"","pno":"757\/998-1644","cno":"757\/998-1644","email":"","ename":"","eno":"","pphy":"BLANCHARD, JEFFREY G MD","ppno":"757\/707-3669","pcpadd":"132 PROFESSIONAL CIRCLE","pcpcity":"WILLIAMSBURG","pcpstate":"VA","pcpzip":23185,"pcpcounty":"","pcpid":157538,"pcpname":"WILLIAMSBURG FAMILY MEDICINE","plan":"OHP","program":"ACA","lob":"Individual","region":"TIDEWATER","aligned":"","ano":"757\/279-4038","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/903-4304","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z02.0","B20.","K02.9","F43.10","E55.9","L21.9","R05.","Z20.822","Z11.1","M70.21","L02.01","M25.521","R51.9","R09.81","J45.909","Z79.899","Z79.1","L03.113","R22.31","B99.9","M71.521","M71.121"],"date":["2021-07-19","2021-09-23","2021-06-10","2021-06-10","2021-06-10","2021-06-10","2021-09-05","2021-09-05","2021-09-19","2021-09-24","2021-09-21","2021-09-21","2021-09-05","2021-09-05","2021-09-05","2021-09-23","2021-09-05","2021-09-23","2021-09-23","2021-09-23","2021-09-23","2021-09-23"],"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":[["","61958200201","DESCOVY","200\/25MG","30","Select","Select",""],["","65862042005","SMZ\/TMP","800-160","30","Select","Select",""],["","45802046564","KETOCONAZOLE","2%","120","Select","Select",""],["","59676057530","PREZCOBIX","800-150","30","Select","Select",""],["","61958200201","DESCOVY ","200\/25MG","-30","Select","Select",""],["","45802046564","KETOCONAZOLE ","2%","120","Select","Select",""],["","59676057530","PREZCOBIX ","800-150","30","Select","Select",""],["","65862042005","SMZ\/TMP ","800-160","30","Select","Select",""],["","42571025101","CLINDAMYCIN","150MG","-63","Select","Select",""],["","67877021901","CEPHALEXIN","500MG","40","Select","Select",""],["","00406051201","OXYCOD\/APAP","5-325MG","-12","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","69238110005","DOXYCYCL","100MG","20","Select","Select",""],["","66993001968","ALBUTEROL","HFA","18","Select","Select",""],["","42571025101","CLINDAMYCIN ","CAP 150MG","-63","Select","Select",""],["","00406051201","OXYCOD\/APAP ","TAB 5-325MG","-12","Select","Select",""],["","67877021901","CEPHALEXIN ","CAP 500MG","40","Select","Select",""],["","59310057922","PROAIR ","AER ","8","Select","Select",""],["","69238110005","DOXYCYCL ","CAP 100MG","20","Select","Select",""],["","66993001968","ALBUTEROL ","AER HFA","18","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":""}]}]}