{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"NATHANIEL   RAY MORETTI","gend":0,"add":"6824 LAKESHORE DR","city":"QUINTON","state":"VA","zip":"23141-9998","dob":"1982-12-20","age":"","mstatus":"","insh":"2260266*01","cliId":"","pno":"401\/636-1919","cno":"401\/636-1919","email":"","ename":"","eno":"","pphy":"GOKLI, ANUP J MD","ppno":"804\/932-4388","pcpadd":"1850 POCAHONTAS TRAIL","pcpcity":"QUINTON","pcpstate":"VA","pcpzip":23141,"pcpcounty":"","pcpid":671676,"pcpname":"","plan":"OHP","program":"ACA","lob":"Individual","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/932-9860","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z20.822","E03.9","E06.3","Z79.899","Z00.00","F41.9","E05.90","L20.9"],"date":["2021-01-27","2021-07-29","2021-08-12","2021-07-29","2021-02-26","2021-08-12","2021-08-12","2021-07-29"],"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":[["","69238183107","LEVOTHYROXIN ","50MCG","30","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","00093317431","ALBUTEROL ","HFA","-8","Select","Select",""],["","00173085910","BREO ","100-25","60","Select","Select",""],["","69097084805","ESCITALOPRAM ","10MG","-30","Select","Select",""],["","51672128202","TRIAMCINOLON ","0.10%","-30","Select","Select",""],["","16571020210","DICLOFENAC ","50MG DR","42","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","00093317431","ALBUTEROL","HFA","-8","Select","Select",""],["","69238183107","LEVOTHYROXIN","50MCG","30","Select","Select",""],["","00173085910","BREO","100-25","60","Select","Select",""],["","51672128202","TRIAMCINOLON","0.10%","30","Select","Select",""],["","69097084805","ESCITALOPRAM","10MG","-30","Select","Select",""],["","16571020210","DICLOFENAC","50MG DR","42","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":""}]}]}