{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"GEOFF KRUTH","gend":0,"add":"2012 ABSALOM DR","city":"VIRGINIA BEACH","state":"VA","zip":"23451-9998","dob":"1975-07-15","age":"","mstatus":"","insh":"2313132*01","cliId":"","pno":"707\/321-6292","cno":"707\/321-6292","email":"","ename":"","eno":"","pphy":"MCDERMOTT, GLENN MD","ppno":"757\/412-0006","pcpadd":"1368 N GREAT NECK RD","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23454,"pcpcounty":"","pcpid":165136,"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":["R74.8","R94.5","E78.00","R79.89","R10.84","R19.4","K74.01","K74.02","Z88.0","L71.9","F41.9","S29.019A","R79.9","E78.2","Z20.828","K59.00","R10.9","H57.89","Z77.098","H53.8","D22.5","D18.01","L82.0","M10.9","Z80.42","Z12.5","Z23.","J45.909","Z20.822","Z79.899","R74.01","E78.5","Z12.11","Z83.71","K64.0","K57.30"],"date":["2020-12-01","2020-11-02","2021-04-06","2020-11-02","2020-11-02","2020-12-01","2020-12-01","2020-12-01","2020-12-01","2021-04-06","2021-04-06","2021-04-06","2021-04-06","2021-04-15","2020-07-25","2020-11-02","2020-11-02","2020-11-28","2020-11-28","2020-11-28","2020-09-01","2020-09-01","2020-09-01","2020-09-25","2020-09-25","2020-09-25","2020-09-25","2020-09-25","2021-01-05","2020-09-25","2020-12-21","2020-12-21","2020-12-30","2020-12-30","2020-12-30","2020-12-30"],"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":[["","00093317431","ALBUTEROL","HFA","8","Select","Select",""],["","63304069201","CLINDAMYCIN","150MG","30","Select","Select",""],["","70710120901","ALLOPURINOL","100MG","90","Select","Select",""],["","51672411606","METRONIDAZOL","0.75%","45","Select","Select",""],["","24208091055","ERYTHROMYCIN","5MG\/GM","4","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","70377000612","ROSUVASTATIN","5MG","90","Select","Select",""],["","13107015590","PAROXETINE","20MG","90","Select","Select",""],["","00591565810","CYCLOBENZAPR","10MG","30","Select","Select",""],["","70710120901","ALLOPURINOL ","100MG","90","Select","Select",""],["","51672411606","METRONIDAZOL ","0.75%","45","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","00093317431","ALBUTEROL ","HFA","8","Select","Select",""],["","63304069201","CLINDAMYCIN ","150MG","30","Select","Select",""],["","24208091055","ERYTHROMYCIN ","5MG\/GM","4","Select","Select",""],["","13107015590","PAROXETINE ","20MG","90","Select","Select",""],["","00591565810","CYCLOBENZAPR ","10MG","30","Select","Select",""],["","70377000612","ROSUVASTATIN ","5MG","90","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":""}]}]}