{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ERIC   PAUL FAES","gend":0,"add":"263 LITTLETOWN QUARTER","city":"WILLIAMSBURG","state":"VA","zip":"23185-9998","dob":"1984-02-21","age":"","mstatus":"","insh":"2260103*01","cliId":"","pno":"936\/662-4641","cno":"936\/662-4641","email":"","ename":"","eno":"","pphy":"HUNDT, DAVID MD","ppno":"757\/564-8182","pcpadd":"227 MCLAWS CIRCLE","pcpcity":"WILLIAMSBURG","pcpstate":"VA","pcpzip":23185,"pcpcounty":"","pcpid":127271,"pcpname":"","plan":"OHP","program":"ACA","lob":"Individual","region":"TIDEWATER","aligned":"","ano":"248\/645-0843","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/564-0077","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M54.2","M50.21","M50.321","M48.02","F31.2","F14.120","F12.20","F10.20","R53.1","Z98.890","M54.12","T15.90XA","A63.0","F31.9","M47.812","Z79.899","J30.81","Z88.8","M89.48","M19.021","M25.521"],"date":["2020-06-02","2020-07-11","2020-08-19","2020-07-11","2020-04-14","2020-04-14","2020-04-14","2020-04-14","2020-04-23","2020-04-23","2020-09-14","2020-07-11","2021-02-11","2021-02-10","2021-02-10","2021-02-10","2021-02-10","2021-02-10","2020-07-11","2021-09-21","2021-09-21"],"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":[["","65862049501","QUETIAPINE","400MG","30","Select","Select",""],["","51525590101","CARISOPRODOL","250MG","30","Select","Select",""],["","00591320413","PODOFILOX","0.50%","-4","Select","Select",""],["","00406012301","HYDROCO\/APAP","5-325MG","10","Select","Select",""],["","68180012202","CEPHALEXIN","500MG","4","Select","Select",""],["","65862049501","QUETIAPINE ","400MG","30","Select","Select",""],["","51525590101","CARISOPRODOL ","250MG","30","Select","Select",""],["","00591320413","PODOFILOX ","0.50%","4","Select","Select",""],["","00406012301","HYDROCO\/APAP ","5-325MG","10","Select","Select",""],["","68180012202","CEPHALEXIN ","500MG","4","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":""}]}]}