{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ANGELA   M OLDS","gend":1,"add":"3420 CHAMPLAIN LN","city":"VIRGINIA BEACH","state":"VA","zip":"23452-9998","dob":"1968-10-01","age":"","mstatus":"","insh":"2056978*01","cliId":"","pno":"757\/270-3470","cno":"757\/270-3470","email":"","ename":"","eno":"","pphy":"ALBALA, TODD MD","ppno":"757\/395-6630","pcpadd":"1080 FIRST COLONIAL RD STE 200","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23454,"pcpcounty":"","pcpid":117381,"pcpname":"SMG - Sentara Family Medicine Physicians - 1080 Bldg","plan":"OHP","program":"ACA","lob":"Small Group","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":["D50.9","I10.","E11.9","I50.30","E78.2"],"date":["2021-07-20","2021-08-30","2021-08-30","2021-08-30","2021-08-30"],"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":[["","68645019059","METOPROL","50MG","180","Select","Select",""],["","53885027150","ONETOUCH","VERIO","50","Select","Select",""],["","43547040211","FUROSEMIDE","40MG","30","Select","Select",""],["","68645048154","ATORVASTATIN","20MG","90","Select","Select",""],["","68645051554","AMLODIPINE","5MG","90","Select","Select",""],["","80777027398","MODERNA","COVID-19","0","Select","Select",""],["","49281042050","FLUZONE","2020-21","0","Select","Select",""],["","68645019059","METOPROL ","50MG","180","Select","Select",""],["","68645048154","ATORVASTATIN ","20MG","90","Select","Select",""],["","53885027150","ONETOUCH ","VERIO","50","Select","Select",""],["","43547040211","FUROSEMIDE ","40MG","30","Select","Select",""],["","68645051554","AMLODIPINE ","5MG","30","Select","Select",""],["","49281042050","FLUZONE ","2020-21","0","Select","Select",""],["","80777027399","MODERNA ","COVID-19","0","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":""}]}]}