{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DANNIE   G WYATT","gend":0,"add":"114 ANDOVER CT","city":"YORKTOWN","state":"VA","zip":"23693-9998","dob":"1976-04-02","pno":"757\/764-4648","cno":"757\/764-4648","email":"","pphy":"DEFIGLIO SMITH, ANN MARIE D MD","ppno":"","pcpadd":"307 COOK ROAD","pcpcity":"YORKTOWN","pcpstate":"VA","pcpzip":23690,"pcpcounty":"","pcpid":157501,"pcpname":"YORKTOWN FAMILY MEDICINE","insh":"2279607*01","cliId":"","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/890-0139","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F41.1","F33.1","R07.9","I21.4","I10.","R79.89","Z72.0","R07.89","R77.8","E78.5","S62.525B","S61.112A","W23.0XXA","R55.","H53.9","T78.40XA","S62.525D","S61.112D","W23.0XXD","I25.10","Z95.5","F17.200","F43.12","S61.102D","I25.110","Z79.02","F17.210","H54.7","Z79.899","Z88.5","Z79.1"],"date":["2021-10-13","2021-10-13","2021-03-09","2021-03-19","2021-05-06","2021-03-09","2021-03-09","2021-03-07","2021-03-09","2021-05-06","2020-10-14","2020-10-14","2020-10-14","2020-10-19","2020-10-19","2020-10-19","2020-10-21","2020-10-21","2020-10-21","2021-03-19","2021-03-19","2021-03-19","2021-10-13","2020-10-05","2021-05-06","2021-05-06","2021-05-06","2021-03-07","2021-03-07","2021-03-07","2021-03-07"],"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":[["","00406012305","HYDROCO\/APAP","5-325MG","12","Select","Select",""],["","49502010202","EPINEPHRINE","0.3MG","-2","Select","Select",""],["","65862001205","SERTRALINE","50MG","30","Select","Select",""],["","59746000103","METHYLPRED","4MG","21","Select","Select",""],["","55111012405","ATORVASTATIN","80MG","90","Select","Select",""],["","45963070996","METOPROL","25MG ER","30","Select","Select",""],["","60505464303","PRASUGREL","10MG","30","Select","Select",""],["","59762330403","NITROGLYCERN","0.4MG","25","Select","Select",""],["","96295012931","BLOOD","MONITOR","1","Select","Select",""],["","43598044874","NICOTINE","21MG\/24H","28","Select","Select",""],["","00093314705","CEPHALEXIN","500MG","21","Select","Select",""],["","00069047103","CHANTIX","0.5& 1MG","-53","Select","Select",""],["","31722088390","ROSUVASTATIN","10MG","-30","Select","Select",""],["","68382050010","OMEPRAZOLE","40MG","30","Select","Select",""],["","00406012305","HYDROCO\/APAP ","TAB 5-325MG","-12","Select","Select",""],["","00093314705","CEPHALEXIN ","CAP 500MG","21","Select","Select",""],["","65862001205","SERTRALINE ","TAB 50MG","30","Select","Select",""],["","49502010202","EPINEPHRINE ","INJ 0.3MG","2","Select","Select",""],["","59762330403","NITROGLYCERN ","SUB 0.4MG","25","Select","Select",""],["","96295012931","BLOOD ","MIS MONITOR","1","Select","Select",""],["","55111012405","ATORVASTATIN ","TAB 80MG","90","Select","Select",""],["","43598044874","NICOTINE ","DIS 21MG\/24H","28","Select","Select",""],["","65862083030","PRASUGREL ","TAB 10MG","30","Select","Select",""],["","45963070911","METOPROL ","TAB 25MG ER","90","Select","Select",""],["","00069047103","CHANTIX ","PAK 0.5& 1MG","53","Select","Select",""],["","31722088390","ROSUVASTATIN ","TAB 10MG","30","Select","Select",""],["","00172392670","DIAZEPAM ","TAB 5MG","-5","Select","Select",""],["","68382050010","OMEPRAZOLE ","CAP 40MG","-30","Select","Select",""],["","59746000103","METHYLPRED ","TAB 4MG","21","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":""}]}]}