{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DAVID   M HODGSON","gend":0,"add":"956 BOBOLINK DR","city":"VIRGINIA BEACH","state":"VA","zip":"23451-9998","dob":"1974-09-26","age":"","mstatus":"","insh":"2269395*01","cliId":"","pno":"757\/291-6401","cno":"757\/291-6401","email":"","ename":"","eno":"","pphy":"WADDELL, DAVID T MD","ppno":"757\/962-6262","pcpadd":"STE A 1856 COLONIAL MED CT","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23454,"pcpcounty":"","pcpid":143803,"pcpname":"Waddell Family Medicine PC","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/962-1185","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z00.00","Z68.28","Z13.89","Z12.11","M76.61","R79.89","R94.5","R10.9","Z23.","I48.0","R10.84","I10.","Z79.899","R19.5","M25.571","E78.5","I77.810","L82.1","L91.8","K92.2","Z20.828","R50.9","U07.1","L24.5","D22.5","L29.8","K40.90"],"date":["2021-11-05","2021-11-05","2020-08-20","2021-11-05","2020-07-28","2020-09-28","2020-09-28","2020-10-08","2021-11-05","2020-07-15","2020-09-30","2020-09-30","2020-09-30","2020-09-30","2020-07-07","2020-08-20","2020-01-20","2021-06-22","2020-06-22","2020-09-30","2020-11-16","2020-11-16","2020-11-16","2021-06-22","2021-06-22","2021-06-22","2021-11-22"],"priorHcc":[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":[["","55111046605","METOPROL","25MG ER","-45","Select","Select",""],["","70377002911","ATORVASTATIN","40MG","-90","Select","Select",""],["","27241011303","TADALAFIL","10MG","3","Select","Select",""],["","00143122710","DICYCLOMINE","20MG","30","Select","Select",""],["","70377002911","ATORVASTATIN ","40MG","-90","Select","Select",""],["","55111046605","METOPROL ","25MG ER","-45","Select","Select",""],["","27241011303","TADALAFIL ","10MG","3","Select","Select",""],["","00143122710","DICYCLOMINE ","20MG","30","Select","Select",""],["","42806054701","VITAMIN","1.25MG","13","Select","Select",""],["","42806054701","VITAMIN ","CAP 1.25MG","13","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":""}]}]}