{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DEBRA   W LANE","gend":1,"add":"712 MANDARIN LN","city":"CHESAPEAKE","state":"VA","zip":"23323-9998","dob":"1956-10-24","age":"","mstatus":"","insh":"2086114*01","cliId":"","pno":"757\/487-4078","cno":"757\/487-4078","email":"","ename":"","eno":"","pphy":"KAPOOR, SONIA MD","ppno":"757\/548-0076","pcpadd":"SUITE 100 725 VOLVO PKWY","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":23320,"pcpcounty":"","pcpid":134965,"pcpname":"Family Physicians of Chesapeake","plan":"OHP","program":"ACA","lob":"Individual","region":"TIDEWATER","aligned":"","ano":"757\/404-9828","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/548-4652","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R73.03","I10.","E03.9","L93.0","Z23.","Z01.419","R39.11","R73.09","M32.9","Z79.899","H35.363","H25.813","Z12.11","Z12.31","N39.0","R35.0","I73.00","R53.83","E55.9"],"date":["2021-04-06","2021-04-06","2021-04-06","2021-04-06","2021-04-13","2020-11-13","2021-01-06","2020-08-18","2020-08-18","2020-08-18","2020-08-18","2020-08-18","2021-05-23","2021-07-30","2021-01-06","2020-03-17","2020-09-17","2020-09-17","2021-03-30"],"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":[["","00781518092","LEVOTHYROXIN","25MCG","30","Select","Select",""],["","00591086201","LISINOP\/HCTZ","20-25MG","30","Select","Select",""],["","00591304101","HYDROXYCHLOR","200MG","30","Select","Select",""],["","67877019805","AMLODIPINE","5MG","30","Select","Select",""],["","57237002901","AMOXICILLIN","875MG","10","Select","Select",""],["","00591304101","HYDROXYCHLOR ","200MG","30","Select","Select",""],["","00591086201","LISINOP\/HCTZ ","20-25MG","30","Select","Select",""],["","00781518092","LEVOTHYROXIN ","25MCG","30","Select","Select",""],["","67877019805","AMLODIPINE ","5MG","30","Select","Select",""],["","57237002901","AMOXICILLIN ","875MG","10","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":""}]}]}