{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CHRISTOPHER   BRIAN LEE","gend":0,"add":"3413 MONTICELLO DR","city":"VIRGINIA BEACH","state":"VA","zip":"23464-9998","dob":"1972-08-25","age":"","mstatus":"","insh":"2256356*01","cliId":"","pno":"757\/218-5966","cno":"757\/218-5966","email":"","ename":"","eno":"","pphy":"ZELINSKAS, DAVID J DO","ppno":"757\/420-8297","pcpadd":"1016 JUSTIS STREET","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":23325,"pcpcounty":"","pcpid":163774,"pcpname":"INDIAN RIVER FAMILY PRACTICE","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":["I10.","I25.10","E78.00","I25.83","Z68.28","F31.9","K62.5","I25.2","Z95.5","Z79.02","K64.9","B35.4","D22.5","Z85.828","Z08.","L57.0","K57.30","K64.0","I20.0","R73.01","Z11.59","R09.3","J31.0","R43.0","R05.","Z68.25","J68.0","R06.02","Z23.","Z00.00","Z87.891","Z79.51","Z77.22","Z77.090"],"date":["2021-10-22","2021-05-18","2021-10-22","2020-08-13","2020-02-28","2020-08-31","2021-06-15","2021-05-18","2021-05-18","2021-05-18","2021-05-18","2021-05-05","2021-05-05","2021-05-05","2021-05-05","2021-05-05","2021-06-15","2021-06-15","2021-06-01","2021-10-22","2021-04-22","2021-07-15","2021-07-26","2021-07-26","2021-07-26","2021-10-22","2021-10-01","2021-09-15","2021-10-22","2021-10-22","2021-10-01","2021-10-01","2021-10-01","2021-10-01"],"priorHcc":[null,"",null,"","","","","","","","","","","","","","","","",null,"","","","","",null,null,"",null,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":[["","59762330401","NITROGLYCERN","0.4MG","-25","Select","Select",""],["","43547035411","LISINOPRIL","20MG","90","Select","Select",""],["","45963070911","METOPROL","25MG ER","30","Select","Select",""],["","00186077660","BRILINTA","60MG","60","Select","Select",""],["","68382000610","LAMOTRIGINE","25MG","120","Select","Select",""],["","16714087701","ATORVASTATIN","80MG","-30","Select","Select",""],["","00456140230","BYSTOLIC","2.5MG","30","Select","Select",""],["","00781261305","AMOXICILLIN","500MG","30","Select","Select",""],["","45802047264","HC","2.5-1%","30","Select","Select",""],["","16729021816","CLOPIDOGREL","75MG","90","Select","Select",""],["","67877032105","IBUPROFEN","800MG","32","Select","Select",""],["","52268001201","SUPREP","PREP KIT","354","Select","Select",""],["","59762330401","NITROGLYCERN ","0.4MG","-25","Select","Select",""],["","45963070911","METOPROL ","25MG ER","90","Select","Select",""],["","43547035411","LISINOPRIL ","20MG","90","Select","Select",""],["","16714087701","ATORVASTATIN ","80MG","30","Select","Select",""],["","51672413001","LAMOTRIGINE ","25MG","120","Select","Select",""],["","00186077660","BRILINTA ","60MG","60","Select","Select",""],["","00456140230","BYSTOLIC ","2.5MG","30","Select","Select",""],["","67877032105","IBUPROFEN ","800MG","32","Select","Select",""],["","16729021816","CLOPIDOGREL ","75MG","90","Select","Select",""],["","00781261305","AMOXICILLIN ","500MG","30","Select","Select",""],["","45802047264","HC ","2.5-1%","30","Select","Select",""],["","52268001201","SUPREP ","PREP KIT","354","Select","Select",""],["","00173088214","BREO","200-25","28","Select","Select",""],["","62559027530","NEBIVOLOL","2.5MG","30","Select","Select",""],["","00173088214","BREO ","INH 200-25","-60","Select","Select",""],["","62559027530","NEBIVOLOL ","TAB 2.5MG","30","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":""}]}]}