{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"PATRICK   SEAN MCNAMARA","gend":0,"add":"1676 WICOMICO LN","city":"VIRGINIA BEACH","state":"VA","zip":"23464-9998","dob":"1960-05-19","age":"","mstatus":"","insh":"2098178*01","cliId":"","pno":"757\/343-0615","cno":"757\/343-0615","email":"","ename":"","eno":"","pphy":"","ppno":"","pcpadd":"","pcpcity":"","pcpstate":"","pcpzip":"","pcpcounty":"","pcpid":"","pcpname":"","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":["C91.10","R53.83","C44.320","E87.6","I49.8","R53.82","R55.","I42.9","I48.91","Z79.01","L82.0","I49.1","I49.3","E55.9","E78.2","F41.9","M62.81","R05.","R25.2","R61.","R63.0","R49.8","Z71.82","I70.0","R94.31","I51.7","R03.0","I49.9","E78.5","Z87.891","Z79.82","Z79.899","R07.9","Z23.","E16.2"],"date":["2021-11-19","2020-12-16","2020-11-20","2020-11-20","2020-11-20","2020-11-20","2021-10-01","2020-12-02","2021-11-24","2020-12-02","2020-12-22","2021-08-13","2021-08-13","2020-03-13","2020-03-13","2020-03-13","2020-03-13","2020-03-13","2020-03-13","2021-05-28","2020-03-13","2020-03-13","2020-03-13","2020-12-02","2020-11-24","2020-11-24","2021-08-13","2021-08-13","2021-08-13","2021-08-13","2021-08-13","2021-08-13","2021-08-13","2021-10-01","2021-10-01"],"priorHcc":[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":[["","57962014009","IMBRUVICA","140MG","90","Select","Select",""],["","75834002001","VITAMIN","50000UNT","4","Select","Select",""],["","70377002711","ATORVASTATIN","10MG","30","Select","Select",""],["","70436015301","POT CHLORIDE","20MEQ ER","60","Select","Select",""],["","68382002210","ATENOLOL","25MG","30","Select","Select",""],["","57962014009","IMBRUVICA ","CAP 140MG","90","Select","Select",""],["","70377002711","ATORVASTATIN ","TAB 10MG","30","Select","Select",""],["","75834002001","VITAMIN ","CAP 50000UNT","4","Select","Select",""],["","70436015301","POT  CHLORIDE","TAB 20MEQ ER","60","Select","Select",""],["","68382002210","ATENOLOL ","TAB 25MG","30","Select","Select",""],["","52817036000","METOPROL ","TAB 25MG","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":[[["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":""}]}]}