{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"PEPITO CAVA","gend":0,"add":"812 MATYIKO DR UNIT A","city":"VIRGINIA BEACH","state":"VA","zip":"23464-9998","dob":"1956-02-03","age":"","mstatus":"","insh":"2246842*01","cliId":"","pno":"757\/404-0869","cno":"757\/404-0869","email":"","ename":"","eno":"","pphy":"MANDELL JR, M STEPHEN MD","ppno":"804\/633-5840","pcpadd":"121 COURTHOUSE LN","pcpcity":"BOWLING GREEN","pcpstate":"VA","pcpzip":22427,"pcpcounty":"","pcpid":195552,"pcpname":"","plan":"OHP","program":"ACA","lob":"Individual","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/633-4438","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R50.9","M25.461","N18.6","Z99.2","Z87.891","T82.858A","T82.898A","T82.590A","I87.1","I87.8","R05.","M10.9","R91.8","R07.9","R91.1","Z00.00","R10.84","R07.89","I12.0","Z20.828","R10.9","K59.00","I10.","Z49.01","R06.2","Z88.1","M54.9","M25.561","J44.1","E87.5","K76.9","E04.1","Z87.442","Z87.11","R07.81","Z12.11","N18.5","I13.11","N25.81","N18.9"],"date":["2020-03-20","2020-03-20","2021-10-01","2021-01-21","2021-01-21","2020-04-21","2020-04-21","2020-04-21","2020-04-21","2020-04-21","2020-09-23","2021-01-15","2020-07-09","2020-09-23","2020-09-23","2021-01-15","2020-07-09","2020-07-09","2021-01-21","2020-09-12","2020-07-09","2021-01-21","2021-01-21","2020-06-16","2020-09-12","2021-01-21","2021-01-21","2020-03-20","2020-09-23","2020-09-23","2020-09-23","2020-09-23","2020-09-23","2020-09-23","2020-09-23","2021-01-15","2021-01-15","2021-01-15","2020-08-17","2021-08-01"],"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":[["","49230064551","VELPHORO ","500MG","90","Select","Select",""],["","65862092127","SEVELAMER ","800MG","180","Select","Select",""],["","68180082046","LANTHANUM ","750MG","90","Select","Select",""],["","64380088404","CINACALCET ","60MG","30","Select","Select",""],["","65862092127","SEVELAMER","800MG","180","Select","Select",""],["","64380088304","CINACALCET","30MG","30","Select","Select",""],["","68180082046","LANTHANUM","750MG","90","Select","Select",""],["","49230064551","VELPHORO","500MG","90","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":""}]}]}