{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MICHAEL   JAMES FERRETTI","gend":0,"add":"440 WEST PLANTATION ROAD","city":"VIRGINIA BEACH","state":"VA","zip":"23454-9998","dob":"1972-05-19","age":"","mstatus":"","insh":"2312397*01","cliId":"","pno":"757\/374-6186","cno":"757\/374-6186","email":"","ename":"","eno":"","pphy":"","ppno":"","pcpadd":"","pcpcity":"","pcpstate":"","pcpzip":"","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"ACA","lob":"Individual","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R07.9","R06.02","F17.210","Z87.891","Z88.6","R13.10","C22.7","C15.9","Z79.899","H53.8","G93.9","Z85.01","C15.5","Z79.1","C22.8","R53.83","R59.0","K76.9","K76.0","B99.8","D84.9","K21.9","K76.1","R10.84","R50.9","C78.7","Z98.890","A41.9","N17.9","D84.821","E87.1","D75.82","E86.1","T45.1X5A","K52.9","E83.42","E87.6","Z20.822","A09.","Z51.11","Z51.12","G62.0","K21.00","R07.89","Z20.828","R19.7","C16.0","R51.9","R10.31","R11.0","R90.82","N32.89","R79.1","S70.362A","L03.116","R16.0","R07.2","Z95.828","M79.10","Z12.11","D12.4","D12.5","K22.8","K31.89","K63.5","Z45.2","R79.89","R61.","M31.5","C78.02","C78.01","C77.8","G47.00","R91.8","C79.9"],"date":["2021-07-22","2021-01-04","2021-07-22","2021-05-03","2021-07-14","2021-03-10","2021-05-05","2021-11-17","2021-07-14","2021-04-29","2021-04-29","2021-07-22","2021-11-19","2021-05-03","2021-05-07","2021-10-20","2021-11-01","2021-07-08","2021-07-08","2021-07-29","2021-07-29","2021-07-14","2021-04-20","2021-07-13","2021-07-19","2021-11-01","2021-04-20","2021-07-20","2021-07-20","2021-07-20","2021-07-14","2021-07-14","2021-07-14","2021-11-17","2021-07-14","2021-07-14","2021-07-14","2021-07-14","2021-07-19","2021-11-19","2021-10-20","2021-11-17","2020-11-30","2020-11-30","2021-03-16","2021-07-22","2021-03-25","2021-07-16","2021-04-20","2021-04-20","2021-04-29","2021-07-13","2021-07-13","2020-08-19","2020-08-19","2021-04-20","2021-01-04","2021-07-08","2021-08-03","2021-03-11","2021-03-10","2021-03-10","2021-03-10","2021-03-10","2021-03-11","2021-05-03","2021-07-22","2021-07-27","2021-08-11","2021-11-01","2021-11-01","2021-11-01","2021-10-20","2021-11-01","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":[["","00143980305","DOXYCYCL","100MG","20","Select","Select",""],["","00363091530","OMEPRAZOLE","20MG","28","Select","Select",""],["","68462010630","ONDANSETRON","8MG","30","Select","Select",""],["","42858030101","HYDROMORPHON","2MG","7","Select","Select",""],["","50111033401","METRONIDAZOL","500MG","18","Select","Select",""],["","69097094312","GABAPENTIN","300MG","150","Select","Select",""],["","00143992801","CIPROFLOXACN","500MG","12","Select","Select",""],["","59746011506","PROCHLORPER","10MG","30","Select","Select",""],["","60505265301","TRAZODONE","50MG","30","Select","Select",""],["","00143980305","DOXYCYCL ","CAP 100MG","20","Select","Select",""],["","00363091530","OMEPRAZOLE ","TAB 20MG","28","Select","Select",""],["","68462010630","ONDANSETRON ","TAB 8MG","30","Select","Select",""],["","42858030101","HYDROMORPHON ","TAB 2MG","7","Select","Select",""],["","27241009706","DULOXETINE ","CAP 20MG","30","Select","Select",""],["","69097094312","GABAPENTIN ","CAP 300MG","150","Select","Select",""],["","50111033401","METRONIDAZOL ","TAB 500MG","18","Select","Select",""],["","59746011506","PROCHLORPER ","TAB 10MG","30","Select","Select",""],["","00406055201","OXYCODONE ","TAB 5MG","-40","Select","Select",""],["","60505265301","TRAZODONE ","TAB 50MG","30","Select","Select",""],["","00143992801","CIPROFLOXACN ","TAB 500MG","12","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":""}]}]}