{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CORY LANNING","gend":0,"add":"19 BAXTER ST","city":"HAMPTON","state":"VA","zip":"23669-9998","dob":"1962-11-23","age":"","mstatus":"","insh":"2258018*01","cliId":"","pno":"702\/204-3799","cno":"702\/204-3799","email":"","ename":"","eno":"","pphy":"CHAN, YU KWAN MD","ppno":"757\/838-6335","pcpadd":"9 MANHATTAN SQ STE A","pcpcity":"HAMPTON","pcpstate":"VA","pcpzip":23666,"pcpcounty":"","pcpid":410067,"pcpname":"Hampton Family Practice, PLLC","plan":"OHP","program":"ACA","lob":"Individual","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/838-0612","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I50.21","I42.0","I48.0","Z01.812","I48.19","I50.22","I42.8","I48.91","I95.89","I48.92","D48.5","I48.3","Z79.01","I49.5","I51.3","Z00.00","I50.9","I51.7","D71.","I11.0","I50.23","I77.810","I51.89","R00.1","Z79.899","E85.9","I95.9","Z12.11","K62.5","R55.","R91.1","Z20.822","R57.8","I49.8","K92.2"],"date":["2020-03-06","2020-05-22","2020-03-12","2020-06-13","2021-08-13","2021-11-02","2021-03-10","2021-11-22","2020-01-21","2020-01-26","2021-03-24","2021-03-10","2021-03-10","2021-03-10","2020-07-22","2021-03-02","2021-05-17","2021-11-22","2020-06-12","2020-06-16","2020-06-19","2020-12-28","2020-12-28","2020-02-05","2020-02-25","2020-03-12","2020-03-12","2021-11-01","2021-11-22","2021-11-22","2021-11-22","2021-10-09","2021-11-24","2021-11-10","2021-11-22"],"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":[["","43547040111","FUROSEMIDE","20MG","60","Select","Select",""],["","59746021601","SPIRONOLACT","25MG","30","Select","Select",""],["","43547035210","LISINOPRIL","5MG","30","Select","Select",""],["","00003089421","ELIQUIS","5MG","60","Select","Select",""],["","65862006201","METOPROL","25MG","60","Select","Select",""],["","68462016201","CARVEDILOL","3.125MG","60","Select","Select",""],["","00078065920","ENTRESTO","24-26MG","60","Select","Select",""],["","68180012201","CEPHALEXIN","500MG","10","Select","Select",""],["","00406048401","APAP\/CODEINE","300-30MG","15","Select","Select",""],["","65862006201","METOPROL ","25MG","60","Select","Select",""],["","00003089421","ELIQUIS ","5MG","60","Select","Select",""],["","43547035210","LISINOPRIL ","5MG","30","Select","Select",""],["","43547040111","FUROSEMIDE ","20MG","60","Select","Select",""],["","59746021601","SPIRONOLACT ","25MG","30","Select","Select",""],["","68462016201","CARVEDILOL ","3.125MG","60","Select","Select",""],["","00078065920","ENTRESTO ","24-26MG","-60","Select","Select",""],["","00406048401","APAP\/CODEINE ","300-30MG","15","Select","Select",""],["","68180012201","CEPHALEXIN ","500MG","10","Select","Select",""],["","59267100002","PFIZER","COVID-19","0","Select","Select",""],["","59267100002","PFIZER ","INJ COVID-19","0","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":""}]}]}