{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ALEX RICHARDS","gend":0,"add":"1509 STALLS WAY","city":"VIRGINIA BEACH","state":"VA","zip":"23453-9998","dob":"1954-07-28","age":"","mstatus":"","insh":"2080896*01","cliId":"","pno":"757\/650-9458","cno":"757\/650-9458","email":"","ename":"","eno":"","pphy":"MANDELL JR, M STEPHEN MD","ppno":"804\/633-5840","pcpadd":"121 COURTHOUSE LN","pcpcity":"BOWLING GREEN","pcpstate":"VA","pcpzip":22427,"pcpcounty":"","pcpid":195552,"pcpname":"","plan":"OHP","program":"ACA","lob":"Individual","region":"TIDEWATER","aligned":"","ano":"757\/650-0446","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":["Z00.00","Z23.","Z95.5","R00.2","R73.9","I25.10","Z87.891","Z13.6","R91.1","C34.90","R06.00","J90.","J98.11","C34.31","K46.9","Z90.2","J44.9","J94.9","Z72.0","E78.5","R49.0","H61.23","J43.9","J98.4","R91.8","G47.33","Z48.812","Z11.59","S21.109A","R06.02","Z98.890","F17.210","R07.9","R06.83","J94.8","J43.2","I71.4","Z01.810","Z01.812","T79.7XXA","Z79.82","Z79.899","Z88.0","Z88.8","Z87.442","Z82.49","Z80.1","E78.00","J93.9","Z20.828","I49.3","Z12.2","F17.200","S61.012A","Z13.89","Z46.82","J18.9","T81.89XA","I25.2","G47.30","K21.9","N28.1"],"date":["2020-02-06","2020-11-19","2020-09-11","2020-02-06","2020-11-19","2021-08-20","2020-09-11","2020-02-11","2021-04-01","2021-04-01","2020-06-17","2020-07-16","2021-10-02","2021-10-04","2020-08-11","2021-10-02","2020-11-04","2020-08-12","2020-08-28","2021-08-20","2020-12-01","2020-11-19","2021-10-02","2021-04-01","2021-04-01","2020-09-11","2020-06-01","2020-06-26","2020-06-30","2020-06-21","2020-11-04","2020-11-04","2020-06-23","2020-10-03","2020-11-04","2020-02-04","2020-02-11","2020-03-13","2020-03-13","2020-06-17","2020-06-21","2020-06-29","2020-09-11","2020-09-11","2020-05-28","2020-05-28","2020-05-28","2020-06-29","2020-06-29","2020-09-11","2020-09-11","2020-01-27","2021-08-20","2020-08-30","2020-03-30","2020-05-31","2020-06-22","2020-06-29","2020-06-29","2020-06-29","2020-12-01","2021-10-02"],"priorHcc":["","","","","",null,"","","","","","",null,null,"",null,"","","",null,"","",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":[["","00186077760","BRILINTA","90MG","60","Select","Select",""],["","76385011050","CARVEDILOL","3.125MG","60","Select","Select",""],["","60505294509","EZETIMIBE","10MG","30","Select","Select",""],["","00406012301","HYDROCO\/APAP","5-325MG","8","Select","Select",""],["","51224001060","BENZONATATE","100MG","30","Select","Select",""],["","42858010201","OXYCOD\/APAP","5-325MG","5","Select","Select",""],["","43598043611","NITROGLYCERN","0.4MG","25","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","59651000305","OMEPRAZOLE","40MG","90","Select","Select",""],["","63868085756","TUSSIN","100\/5ML","473","Select","Select",""],["","63304069205","CLINDAMYCIN","150MG","28","Select","Select",""],["","65862007701","CIPROFLOXACN","500MG","14","Select","Select",""],["","55111028130","LEVOFLOXACIN","750MG","6","Select","Select",""],["","68462010530","ONDANSETRON","4MG","30","Select","Select",""],["","59779044870","CVS","21MG\/24H","28","Select","Select",""],["","00093317431","ALBUTEROL","HFA","8","Select","Select",""],["","58657050016","CODEINE\/GG","10-100\/5","40","Select","Select",""],["","60505294509","EZETIMIBE ","10MG","30","Select","Select",""],["","76385011050","CARVEDILOL ","3.125MG","60","Select","Select",""],["","00186077760","BRILINTA ","90MG","60","Select","Select",""],["","00406012301","HYDROCO\/APAP ","5-325MG","8","Select","Select",""],["","68462010530","ONDANSETRON ","4MG","30","Select","Select",""],["","51224001060","BENZONATATE ","100MG","30","Select","Select",""],["","63868085756","TUSSIN ","100\/5ML","473","Select","Select",""],["","42858010201","OXYCOD\/APAP ","5-325MG","5","Select","Select",""],["","65862007701","CIPROFLOXACN ","500MG","-14","Select","Select",""],["","00093317431","ALBUTEROL ","HFA","8","Select","Select",""],["","43598043611","NITROGLYCERN ","0.4MG","25","Select","Select",""],["","58657050016","CODEINE\/GG ","10-100\/5","40","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","59779044870","CVS ","21MG\/24H","28","Select","Select",""],["","55111028130","LEVOFLOXACIN ","750MG","6","Select","Select",""],["","59651000305","OMEPRAZOLE ","40MG","90","Select","Select",""],["","63304069205","CLINDAMYCIN ","150MG","-28","Select","Select",""],["","65862035790","CLOPIDOGREL ","75MG","90","Select","Select",""],["","65862035790","CLOPIDOGREL","75MG","90","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","",""],["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":""}]}]}