{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JAMES WEST","gend":0,"add":"10356 WOODS CROSS ROAD","city":"GLOUCESTER","state":"VA","zip":"23061-9998","dob":"1989-09-26","age":"","mstatus":"","insh":"2031454*01","cliId":"","pno":"804\/693-7217","cno":"804\/693-7217","email":"","ename":"","eno":"","pphy":"VALLS, FRANCISCO X MD","ppno":"804\/693-2720","pcpadd":"STE 2200 7547 MEDICAL DRIVE","pcpcity":"GLOUCESTER","pcpstate":"VA","pcpzip":23061,"pcpcounty":"","pcpid":118380,"pcpname":"Internal Medicine Associates of Gloucester","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":["G80.9","K21.0","J85.1","J69.0","J96.11","E83.51","E83.42","F79.","Z93.1","J20.9","R04.0","J96.01","A41.9","R68.89","J34.2","Z87.09","K11.7","G80.0","H66.90","R91.8","T17.908A","Z97.8","R05.","R00.0","C80.1","K94.23","J85.2","R91.1","J90.","Z03.89","J98.4","R07.9","R50.9","R19.4","I34.0","R52.","J06.9","Z87.01","Z20.822","R09.81","R65.21","J96.91","R04.2","Z20.828","R65.10","R06.02","R09.02","J69.8","G82.50","K21.01","R69.","J96.90","R41.82","I26.99","R63.30"],"date":["2021-10-28","2020-09-01","2020-09-03","2021-01-26","2020-09-03","2020-09-03","2020-09-03","2020-09-03","2020-11-08","2020-11-08","2020-12-31","2020-07-15","2020-07-15","2020-07-15","2021-01-26","2021-01-26","2021-01-26","2021-01-26","2020-04-13","2020-07-08","2020-07-09","2020-07-09","2020-11-08","2020-07-06","2020-07-07","2020-07-10","2020-07-14","2020-07-14","2020-07-14","2021-05-03","2020-07-06","2020-07-06","2020-07-06","2020-07-06","2020-07-06","2020-07-06","2021-05-03","2021-10-12","2021-05-03","2021-05-03","2020-07-07","2020-07-06","2020-07-07","2020-07-06","2020-07-06","2020-12-31","2020-07-06","2020-07-08","2020-01-19","2021-01-29","2020-07-05","2020-07-07","2020-09-14","2020-12-31","2021-10-12"],"priorHcc":[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":[["","00143924920","AMOX\/K","875-125","18","Select","Select",""],["","45802095243","IBUPROFEN","100\/5ML","600","Select","Select",""],["","23900003813","DAYQUIL","COLD\/FLU","240","Select","Select",""],["","50580040308","TYLENOL","CONGEST","240","Select","Select",""],["","00067813208","THERAFLU","SEV CD\/F","240","Select","Select",""],["","70515061001","PRILOSEC","10MG","60","Select","Select",""],["","00187526701","MAGONATE","1000\/5ML","150","Select","Select",""],["","00259050116","CUVPOSA","1MG\/5ML","473","Select","Select",""],["","11822332050","DIPHEDRYL","12.5\/5ML","60","Select","Select",""],["","68180072305","CEFDINIR","250\/5ML","-100","Select","Select",""],["","68180015001","FAMOTIDINE","40MG\/5ML","50","Select","Select",""],["","10006070028","MAG","400MG","14","Select","Select",""],["","69076047501","GLYCOPYRROL","1MG","90","Select","Select",""],["","16729017101","AMITRIPTYLIN","10MG","90","Select","Select",""],["","50383028604","LEVOFLOXACIN","25MG\/ML","75","Select","Select",""],["","69076047501","GLYCOPYRROL ","1MG","90","Select","Select",""],["","11822332050","DIPHEDRYL ","12.5\/5ML","60","Select","Select",""],["","50580040308","TYLENOL ","CONGEST","240","Select","Select",""],["","00187526701","MAGONATE ","1000\/5ML","300","Select","Select",""],["","10006070028","MAG ","400MG","14","Select","Select",""],["","00143924920","AMOX\/K ","875-125","-18","Select","Select",""],["","68180015001","FAMOTIDINE ","40MG\/5ML","50","Select","Select",""],["","45802095243","IBUPROFEN ","100\/5ML","600","Select","Select",""],["","00067813208","THERAFLU ","SEV CD\/F","246","Select","Select",""],["","23900003813","DAYQUIL ","COLD\/FLU","240","Select","Select",""],["","70515061001","PRILOSEC ","10MG","60","Select","Select",""],["","00259050116","CUVPOSA ","1MG\/5ML","-473","Select","Select",""],["","16729017101","AMITRIPTYLIN ","10MG","90","Select","Select",""],["","68180072305","CEFDINIR ","250\/5ML","-100","Select","Select",""],["","50383028604","LEVOFLOXACIN ","25MG\/ML","75","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":""}]}]}