{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JUSTIN   M TRAUGER","gend":0,"add":"1109 WADENA ROAD","city":"CHESAPEAKE","state":"VA","zip":"23320-9998","dob":"1971-12-26","age":"","mstatus":"","insh":"2093310*01","cliId":"","pno":"757\/822-9667","cno":"757\/822-9667","email":"","ename":"","eno":"","pphy":"TAN-GONZALES, DESIREE MD","ppno":"757\/548-0076","pcpadd":"725 VOLVO PKWY SUITE 100","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":23320,"pcpcounty":"","pcpid":129852,"pcpname":"Volvo Medical Associates","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/548-1652","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M50.30","M54.12","M05.79","M25.50","M48.02","M25.78","M50.822","I25.10","I48.0","I10.","I25.5","E78.5","M25.519","E66.9","M47.892","Z87.891","J44.9","G56.03","M51.9","M54.15","M25.512","I05.1","Z71.3","Z68.31","I25.2","Z79.01","Z79.82","Z79.899","Z00.00","Z12.11","I51.89","I48.91"],"date":["2020-05-05","2020-06-22","2021-08-31","2021-04-27","2020-06-02","2020-06-02","2020-06-02","2021-11-10","2021-10-20","2021-10-20","2021-11-23","2021-10-20","2020-06-05","2021-07-20","2020-05-21","2020-06-22","2020-06-22","2020-06-22","2020-04-24","2020-04-24","2020-04-24","2020-08-25","2021-07-20","2021-07-20","2021-07-20","2021-07-20","2021-07-20","2021-07-20","2021-08-31","2021-11-23","2021-11-10","2021-11-23"],"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":[["","66869020490","LIVALO","2MG","15","Select","Select",""],["","68180051301","LISINOPRIL","5MG","30","Select","Select",""],["","59746017509","PREDNISONE","20MG","20","Select","Select",""],["","53746020301","OXYCOD\/APAP","5-325MG","20","Select","Select",""],["","50228018005","GABAPENTIN","300MG","60","Select","Select",""],["","68001015403","CARVEDILOL","6.25MG","60","Select","Select",""],["","59762444002","METHYLPRED","4MG","21","Select","Select",""],["","72511076002","REPATHA","140MG\/ML","-2","Select","Select",""],["","00555057202","METHOTREXATE","2.5MG","72","Select","Select",""],["","59762330403","NITROGLYCERN","0.4MG","25","Select","Select",""],["","67877049090","EZETIMIBE","10MG","90","Select","Select",""],["","69315012701","FOLIC","1000MCG","90","Select","Select",""],["","66869020490","LIVALO ","2MG","15","Select","Select",""],["","68180051301","LISINOPRIL ","5MG","30","Select","Select",""],["","68001015403","CARVEDILOL ","6.25MG","60","Select","Select",""],["","59746017509","PREDNISONE ","20MG","20","Select","Select",""],["","59762444002","METHYLPRED ","4MG","21","Select","Select",""],["","50228018005","GABAPENTIN ","300MG","60","Select","Select",""],["","42858010201","OXYCOD\/APAP ","5-325MG","-20","Select","Select",""],["","72511076002","REPATHA ","140MG\/ML","2","Select","Select",""],["","67877049090","EZETIMIBE ","10MG","90","Select","Select",""],["","59762330403","NITROGLYCERN ","0.4MG","25","Select","Select",""],["","69315012701","FOLIC ","1000MCG","90","Select","Select",""],["","00555057202","METHOTREXATE ","2.5MG","36","Select","Select",""],["","00074055402","HUMIRA ","40\/0.4ML","2","Select","Select",""],["","00074055402","HUMIRA","40\/0.4ML","-2","Select","Select",""],["","10572010101","PEG-3350 ","SOL ELECTROL","4000","Select","Select",""],["","00078065967","ENTRESTO ","TAB 24-26MG","-60","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":""}]}]}