{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DANIEL BARD","gend":0,"add":"19 APPOMATOX AVE","city":"PORTSMOUTH","state":"VA","zip":"23702-9998","dob":"1963-03-05","age":"","mstatus":"","insh":"2160571*01","cliId":"","pno":"757\/805-0207","cno":"757\/805-0207","email":"","ename":"","eno":"","pphy":"RAMOLIA, MANSUKHLAL R MD","ppno":"757\/483-6401","pcpadd":"4035 TAYLOR RD #K","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":23321,"pcpcounty":"","pcpid":210204,"pcpname":"","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"315\/396-6164","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/686-3025","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["A41.9","K57.20","D72.829","R10.9","B96.89","Z48.03","I10.","K21.9","E66.01","Z68.41","M17.0","G47.30","H40.9","Z87.891","Z79.51","Z79.82","R93.89","K57.32","Z68.39","R50.9","R53.83","R19.7","Z20.828","Z79.84","Z79.899","I12.9","E78.2","E11.22","N18.30","M62.89","N28.1","K76.89","E87.1","E11.9","K57.92","R65.20","R06.00","R79.89","R00.0","R07.9","J40.","R65.10","E66.9","Z68.38","Z87.19","J20.9","R06.2","G25.0","I42.0","R06.02","E83.39","Z86.16","Z09.","Z46.82","B99.9","J98.11","Z01.818","N17.9","R82.90","K57.80","R61.","Z00.00","F41.9","J06.9","K65.9","E87.2","Z91.041","E86.0","N40.0","K40.90","Z12.5","K65.8","Z90.49","R10.31","M54.9","U07.1","J12.89","D72.825","Z11.59","I51.7","K92.2","R21.","Z12.11"],"date":["2020-08-05","2021-01-26","2020-08-07","2020-03-25","2020-04-02","2020-04-02","2021-01-26","2021-01-26","2021-01-26","2021-09-02","2020-04-02","2020-04-02","2020-04-02","2021-01-26","2020-04-02","2021-01-26","2020-04-14","2021-01-26","2021-01-26","2020-08-05","2020-07-22","2020-08-07","2020-08-05","2020-08-05","2021-01-26","2021-08-11","2021-07-31","2021-09-02","2021-01-16","2021-01-22","2021-01-22","2021-01-22","2020-08-07","2021-01-26","2021-02-08","2020-03-22","2020-08-04","2021-07-31","2020-08-04","2020-08-04","2020-08-05","2020-08-05","2021-09-02","2020-08-05","2021-01-22","2021-08-11","2021-08-11","2021-08-11","2021-01-20","2021-09-10","2021-01-26","2021-01-26","2020-04-15","2020-04-15","2020-07-22","2020-07-22","2021-01-22","2020-03-27","2020-03-19","2020-04-14","2020-07-22","2021-01-16","2020-09-23","2020-09-23","2020-03-22","2020-03-22","2020-03-22","2020-03-22","2020-03-22","2020-03-22","2020-09-22","2021-01-26","2021-02-08","2020-03-19","2020-06-04","2020-08-04","2020-08-04","2020-08-04","2020-08-05","2021-01-20","2021-07-31","2021-09-02","2021-08-30"],"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":[["","65862029490","ROSUVASTATIN","10MG","30","Select","Select",""],["","53746054401","PRIMIDONE","50MG","270","Select","Select",""],["","08290309581","3ML","25GX1\"","2","Select","Select",""],["","00781307471","TESTOST","200MG\/ML","2","Select","Select",""],["","50111033401","METRONIDAZOL","500MG","20","Select","Select",""],["","00406012301","HYDROCO\/APAP","5-325MG","10","Select","Select",""],["","00603533815","PREDNISONE","10MG","21","Select","Select",""],["","61442010301","DICLOFENAC","75MG DR","180","Select","Select",""],["","67877015905","METFORMIN","500MG ER","60","Select","Select",""],["","68180072003","AMLODIPINE","5MG","90","Select","Select",""],["","68180052001","LISINOP\/HCTZ","20-25MG","90","Select","Select",""],["","13668001001","CITALOPRAM","20MG","30","Select","Select",""],["","52937000120","VASCEPA","1GM","120","Select","Select",""],["","43547043109","FENOFIBRATE","145MG","30","Select","Select",""],["","55111012701","CIPROFLOXACN","500MG","20","Select","Select",""],["","31722072250","LEVOFLOXACIN","500MG","7","Select","Select",""],["","69097094307","GABAPENTIN","300MG","21","Select","Select",""],["","33332032001","AFLURIA","2020-21","0","Select","Select",""],["","45802008801","ALBUTEROL","HFA","8","Select","Select",""],["","10702001801","OXYCODONE","5MG","30","Select","Select",""],["","00781185220","AMOX\/K","875-125","42","Select","Select",""],["","00536117201","ACETAMIN","500MG","56","Select","Select",""],["","65862064163","AZITHROMYCIN","250MG","6","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","65162062750","TRAMADOL","50MG","60","Select","Select",""],["","00093117701","NEOMYCIN","500MG","6","Select","Select",""],["","53746054401","PRIMIDONE ","50MG","270","Select","Select",""],["","65862029490","ROSUVASTATIN ","10MG","30","Select","Select",""],["","67877015905","METFORMIN ","500MG ER","60","Select","Select",""],["","68180072003","AMLODIPINE ","5MG","90","Select","Select",""],["","08290309581","3ML ","25GX1\"","2","Select","Select",""],["","61442010301","DICLOFENAC ","75MG DR","180","Select","Select",""],["","68180052001","LISINOP\/HCTZ ","20-25MG","90","Select","Select",""],["","00574082001","TESTOST ","200MG\/ML","2","Select","Select",""],["","43547043109","FENOFIBRATE ","145MG","30","Select","Select",""],["","50111033401","METRONIDAZOL ","500MG","20","Select","Select",""],["","00406012301","HYDROCO\/APAP ","5-325MG","10","Select","Select",""],["","55111012701","CIPROFLOXACN ","500MG","42","Select","Select",""],["","00603533815","PREDNISONE ","10MG","21","Select","Select",""],["","00781185220","AMOX\/K ","875-125","42","Select","Select",""],["","13668001001","CITALOPRAM ","20MG","30","Select","Select",""],["","45802008801","ALBUTEROL ","HFA","8","Select","Select",""],["","31722072250","LEVOFLOXACIN ","500MG","7","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","52937000120","VASCEPA ","1GM","120","Select","Select",""],["","65862064163","AZITHROMYCIN ","250MG","6","Select","Select",""],["","33332032001","AFLURIA ","2020-21","0","Select","Select",""],["","69097094307","GABAPENTIN ","300MG","21","Select","Select",""],["","00093117701","NEOMYCIN ","500MG","6","Select","Select",""],["","00536117201","ACETAMIN ","500MG","56","Select","Select",""],["","10702001801","OXYCODONE ","5MG","30","Select","Select",""],["","65162062750","TRAMADOL ","50MG","60","Select","Select",""],["","00173068220","VENTOLIN ","","36","Select","Select",""],["","31722061290","PREGABALIN","75MG","30","Select","Select",""],["","00173068220","VENTOLIN","","36","Select","Select",""],["","31722070530","VALACYCLOVIR","1GM","21","Select","Select",""],["","58160082311","SHINGRIX","50\/0.5ML","1","Select","Select",""],["","80777027398","MODERNA","COVID-19","0","Select","Select",""],["","31722061290","PREGABALIN ","CAP 75MG","30","Select","Select",""],["","80777027398","MODERNA ","INJ COVID-19","0","Select","Select",""],["","58160082311","SHINGRIX ","INJ 50\/0.5ML","1","Select","Select",""],["","31722070530","VALACYCLOVIR ","TAB 1GM","21","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":""}]}]}