{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ROBERT   JOSEPH LONKER","gend":0,"add":"8150 SHORE DR APT 203","city":"NORFOLK","state":"VA","zip":"23518-9998","dob":"1993-10-04","age":"","mstatus":"","insh":"2256419*01","cliId":"","pno":"757\/985-9578","cno":"757\/985-9578","email":"","ename":"","eno":"","pphy":"MCDERMOTT, GLENN MD","ppno":"757\/412-0006","pcpadd":"1368 N GREAT NECK RD","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23454,"pcpcounty":"","pcpid":165136,"pcpname":"","plan":"OHP","program":"ACA","lob":"Individual","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/496-2069","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N48.1","L70.0","D22.9","Z71.9","Z28.21","J01.90","F33.8","Z20.6","R53.82","R07.9","L50.9","R21.","J03.90","A51.9","Z11.3","Z70.8","J02.9","I45.6","R53.83","Z88.0","A53.9","K21.9","J30.9"],"date":["2020-05-22","2020-09-23","2020-09-23","2020-09-23","2020-09-23","2021-07-18","2020-09-27","2020-02-24","2020-02-24","2021-04-22","2020-10-10","2020-10-10","2020-01-11","2020-08-05","2020-08-05","2020-08-05","2021-04-07","2021-04-22","2021-04-22","2021-04-22","2020-01-30","2021-09-08","2021-09-08"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","",""]}},{"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":[["","61958070101","TRUVADA","200-300","30","Select","Select",""],["","00093742698","MONTELUKAST","10MG","10","Select","Select",""],["","00527133850","DOXYCYC","100MG","28","Select","Select",""],["","61958200201","DESCOVY","200\/25","30","Select","Select",""],["","69646070515","ALCORTIN","1-2-1%","48","Select","Select",""],["","00259142028","ONMEL","200MG","-2","Select","Select",""],["","63304069301","CLINDAMYCIN","300MG","30","Select","Select",""],["","68180016013","AZITHROMYCIN","250MG","6","Select","Select",""],["","51672136606","CLINDAMY\/BEN","1.2-5%","45","Select","Select",""],["","49884023911","ITRACONAZOLE","100MG","4","Select","Select",""],["","24658031205","DOXYCYCL","100MG","28","Select","Select",""],["","0","","","120","Select","Select",""],["","13925017448","IODOQU-HC","ALOE","48","Select","Select",""],["","00378064205","PREDNISONE","20MG","12","Select","Select",""],["","00093742698","MONTELUKAST ","10MG","10","Select","Select",""],["","63304069301","CLINDAMYCIN ","300MG","30","Select","Select",""],["","61958070101","TRUVADA ","200-300","30","Select","Select",""],["","00527133850","DOXYCYC ","100MG","28","Select","Select",""],["","61958200201","DESCOVY ","200\/25","-30","Select","Select",""],["","68180016013","AZITHROMYCIN ","250MG","6","Select","Select",""],["","69646070515","ALCORTIN ","1-2-1%","48","Select","Select",""],["","00259142028","ONMEL ","200MG","-2","Select","Select",""],["","49884023911","ITRACONAZOLE ","100MG","4","Select","Select",""],["","24658031205","DOXYCYCL ","100MG","28","Select","Select",""],["","13925017448","IODOQU-HC ","ALOE","48","Select","Select",""],["","51672136606","CLINDAMY\/BEN ","1.2-5%","45","Select","Select",""],["","00378064205","PREDNISONE ","20MG","12","Select","Select",""],["","65162006205","SUCRALFATE","1GM\/10ML","-400","Select","Select",""],["","62175061743","PANTOPRAZOLE","40MG","30","Select","Select",""],["","65162006205","SUCRALFATE ","SUS 1GM\/10ML","-400","Select","Select",""],["","62175061743","PANTOPRAZOLE ","TAB 40MG","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":""}]}]}