{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" ANDRE WILDER","gend":0,"add":"711 BURTON ST","city":"HAMPTON","state":"VA","zip":"23666-9998","dob":"1967-11-06","age":"","mstatus":"","insh":"2023766*01","cliId":"","pno":"757\/753-9438","cno":"757\/753-9438, ","email":"","ename":"","eno":"","pphy":"FELL, ROBERT S DO","ppno":"757\/251-2170","pcpadd":"850 ENTERPRISE PARKWAY 2200","pcpcity":"HAMPTON","pcpstate":"VA","pcpzip":"23666-9998","pcpcounty":"","pcpid":118380,"pcpname":"Riverside Center for Internal & Family Medicine","plan":"OHP - OPTIMA","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":["N19.","N28.1","I21.4","D59.12","E11.22","I12.9","E78.5","F17.200","E66.9","J45.909","I10.","E11.3511","E11.3512","H25.11","H25.12","E11.3493","H52.03","H52.4","M18.11","M19.031","M65.831","M25.531","M17.0","M25.561","M25.551","M16.11","N18.4","E87.5","G47.33","Z12.11","M25.831","I50.9","I11.0","E11.3399","M17.12","E11.9","G47.30","Z72.0","F48.9","Z86.19","R05.","R07.9","R94.30","I13.0","N17.9","E87.2","F17.210","E78.00","I25.10","D63.1","Z83.3","I51.7","N18.5","E21.1","Z00.00","Z12.5","E55.9","J90.","Z71.6","R60.0"],"date":["2021-04-16","2021-04-16","2021-04-22","2021-04-22","2021-04-22","2021-04-22","2021-04-22","2021-04-22","2021-04-22","2021-04-22","2021-05-13","2021-06-08","2021-06-08","2020-10-20","2020-10-20","2020-05-28","2020-05-28","2020-05-28","2020-09-29","2020-09-29","2020-09-29","2020-09-29","2020-12-21","2020-12-21","2020-12-21","2020-12-21","2021-05-13","2021-05-13","2021-05-30","2020-08-31","2020-09-29","2021-04-14","2020-02-18","2020-04-16","2021-01-06","2021-04-18","2021-04-18","2021-04-18","2021-05-17","2021-05-17","2020-02-26","2021-04-14","2020-03-20","2021-04-14","2021-04-30","2021-04-30","2021-04-14","2021-04-14","2021-04-14","2021-04-14","2021-04-14","2021-05-17","2021-05-17","2021-05-13","2020-04-07","2020-01-16","2020-01-16","2021-04-14","2021-04-30","2021-04-30"],"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":[["","00069046903","CHANTIX","1MG","-56","Select","Select",""],["","68382009401","CARVEDILOL","12.5MG","60","Select","Select",""],["","50111032801","HYDRALAZINE","50MG","-90","Select","Select",""],["","00054429931","FUROSEMIDE","40MG","30","Select","Select",""],["","16729000201","GLIMEPIRIDE","2MG","180","Select","Select",""],["","27808015801","ROSUVASTATIN","40MG","30","Select","Select",""],["","68682010610","NIFEDIPINE","60MG ER","30","Select","Select",""],["","00904404073","ASPIRIN","81MG","90","Select","Select",""],["","55111019690","CLOPIDOGREL","75MG","30","Select","Select",""],["","59310057922","PROAIR","","-8","Select","Select",""],["","33332042010","AFLURIA","2020-21","0","Select","Select",""],["","68180063709","ATORVASTATIN","40MG","30","Select","Select",""],["","00406051201","OXYCOD\/APAP","5-325MG","8","Select","Select",""],["","49884025601","MINOXIDIL","2.5MG","180","Select","Select",""],["","59267100001","PFIZER","COVID-19","0","Select","Select",""],["","72647033104","METHYLPRED","4MG","21","Select","Select",""],["","13668010501","ISOSORB","60MG ER","30","Select","Select",""],["","99073070822","FREESTYLE TES LITE","LITE","200","Select","Select",""],["","70010010801","GABAPENTIN","100MG","60","Select","Select",""],["","66993001968","ALBUTEROL","HFA","18","Select","Select",""],["","00536104710","SODIUM","650MG","120","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":[[["Yes","Select","","","","","Select","",""],["Yes","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":""}]}]}