{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TRAVIS   W TRAWICK","gend":0,"add":"2754A HOLLY ROAD","city":"VIRGINIA BEACH","state":"VA","zip":"23451-9998","dob":"1994-06-03","age":"","mstatus":"","insh":"2138544*01","cliId":"","pno":"757\/575-3743","cno":"757\/575-3743","email":"","ename":"","eno":"","pphy":"DOWDY, ROBERT L MD","ppno":"757\/395-2500","pcpadd":"1024 FIRST COLONIAL RD","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23454,"pcpcounty":"","pcpid":117368,"pcpname":"SMG - Resource Pool","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/275-9700","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z20.828","J30.1","J30.81","J30.89","R10.84","R19.7","M25.561","M22.2X1","M22.8X1","M76.51","G89.29","K64.0","R06.02","Z91.09","Z91.038","G44.209","T78.40XS","E78.5","F90.9","R11.0","K29.00"],"date":["2020-11-17","2021-06-08","2021-06-08","2021-06-08","2021-06-30","2021-11-03","2020-07-31","2020-07-31","2020-07-28","2020-07-14","2020-07-31","2021-07-23","2021-04-14","2021-04-14","2021-04-14","2021-07-19","2021-07-19","2021-07-19","2021-07-19","2021-06-29","2021-08-11"],"priorHcc":["","","","","",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":[["","16571020106","DICLOFENAC ","75MG DR","60","Select","Select",""],["","49281072010","FLUBLOK ","2020-21","0","Select","Select",""],["","59310058020","PROAIR ","","-1","Select","Select",""],["","11523433201","CLARITIN-D ","10-240MG","30","Select","Select",""],["","50111033402","METRONIDAZOL ","500MG","42","Select","Select",""],["","57237007710","ONDANSETRON ","4MG ODT","12","Select","Select",""],["","16571020106","DICLOFENAC","75MG DR","60","Select","Select",""],["","49281072010","FLUBLOK","2020-21","0","Select","Select",""],["","59310058020","PROAIR","","1","Select","Select",""],["","11523433201","CLARITIN-D","10-240MG","30","Select","Select",""],["","50111033402","METRONIDAZOL","500MG","42","Select","Select",""],["","57237007710","ONDANSETRON","4MG ODT","12","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":""}]}]}