{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ROBBIN BRETT","gend":1,"add":"517 WARREN CRES 757-477-3023","city":"NORFOLK","state":"VA","zip":"23507-9998","dob":"1957-04-02","age":"","mstatus":"","insh":"2306172*01","cliId":"","pno":"757\/477-3537","cno":"757\/477-3537","email":"","ename":"","eno":"","pphy":"OBERMEYER, PHAIK MD","ppno":"757\/321-6142","pcpadd":"840 FIRST COLONIAL ROAD SUITE 101","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23451,"pcpcounty":"","pcpid":213625,"pcpname":"Hague Medical Associates","plan":"OHP","program":"ACA","lob":"Individual","region":"TIDEWATER","aligned":"","ano":"757\/477-3023","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/321-6145","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F10.20","Z79.899","E83.52","D64.9","K70.30","R56.9","G93.6","J15.211","N17.0","J96.01","J96.02","J98.11","E87.2","G93.40","D32.0","T38.0X5A","R73.9","Z82.49","Z82.62","Z82.61","Z83.79","R91.8","R07.9","S00.03XA","S00.83XA","S05.12XA","Z09.","G40.909","E11.9","R74.8","D50.8","E78.2","D32.9","I10.","K86.2","E03.9","F10.10","F33.0","F41.1","N63.20","E66.9","F41.9","Z99.11","J18.1","N17.9","E87.6","J18.9","D49.6","Z46.59","I85.00","R92.8","I50.9","E64.9","R79.89","R94.5","E78.00","N63.21","R41.82","Z98.890","Z12.11","F10.230","Z20.822","H53.031","Z03.89"],"date":["2021-11-17","2020-07-23","2021-03-31","2020-12-30","2021-03-31","2020-12-06","2020-12-04","2020-12-04","2020-12-04","2020-12-06","2020-12-06","2020-12-02","2020-12-06","2020-12-08","2020-12-04","2020-11-30","2020-11-30","2020-11-30","2020-11-30","2020-11-30","2020-11-30","2020-11-30","2020-11-30","2020-11-30","2020-11-30","2020-11-30","2020-12-14","2021-03-26","2021-03-31","2020-12-15","2020-12-15","2021-03-31","2021-03-31","2021-03-31","2021-03-31","2021-03-31","2021-03-31","2021-11-17","2021-11-17","2020-09-24","2021-03-31","2021-08-16","2020-12-01","2020-12-04","2020-12-15","2020-12-15","2020-11-30","2020-12-06","2020-12-01","2021-03-31","2020-09-24","2020-12-01","2020-12-07","2020-12-30","2020-12-30","2020-12-30","2020-09-24","2020-12-05","2020-12-02","2021-05-23","2021-08-01","2021-10-06","2021-08-31","2021-11-17"],"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":[["","65162055610","TEMAZEPAM ","15MG","30","Select","Select",""],["","69238183107","LEVOTHYROXIN ","50MCG","90","Select","Select",""],["","69097084905","ESCITALOPRAM ","20MG","90","Select","Select",""],["","69452015120","VITAMIN ","50000UNT","12","Select","Select",""],["","65162036111","FOLIC ","1MG","10","Select","Select",""],["","16714035601","LEVETIRACETA ","750MG","60","Select","Select",""],["","00054418125","DEXAMETHASON ","1MG","2","Select","Select",""],["","00093720298","PRAVASTATIN ","40MG","-90","Select","Select",""],["","31604001281","B1 ","100MG","30","Select","Select",""],["","70461032003","FLUCLVX ","2020-21","0","Select","Select",""],["","00406117003","NALTREXONE ","50MG","30","Select","Select",""],["","69238183107","LEVOTHYROXIN","50MCG","90","Select","Select",""],["","65162055610","TEMAZEPAM","15MG","30","Select","Select",""],["","69452015120","VITAMIN","50000UNT","12","Select","Select",""],["","69097084905","ESCITALOPRAM","20MG","-90","Select","Select",""],["","70461032003","FLUCLVX","2020-21","0","Select","Select",""],["","16714035601","LEVETIRACETA","750MG","60","Select","Select",""],["","00054418125","DEXAMETHASON","1MG","2","Select","Select",""],["","00093720298","PRAVASTATIN","40MG","90","Select","Select",""],["","65162036111","FOLIC","1MG","10","Select","Select",""],["","31604001281","B1","100MG","30","Select","Select",""],["","00406117003","NALTREXONE","50MG","30","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":[[["Yes","Select","","","","","Select","",""],["Yes","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":""}]}]}