{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ANTOINETTE TUCKER","gend":1,"add":"1 TUPELO CIR","city":"HAMPTON","state":"VA","zip":"23666-9998","dob":"1959-08-15","age":"","mstatus":"","insh":"3224449*01","cliId":"","pno":"757\/870-0712","cno":"757\/870-0712","email":"","ename":"","eno":"","pphy":"RAINES, TIMOTHY L MD","ppno":"757\/964-7629","pcpadd":"2240 D COLISEUM DR","pcpcity":"HAMPTON","pcpstate":"VA","pcpzip":23666,"pcpcounty":"","pcpid":510027,"pcpname":"","plan":"OHP","program":"ACA","lob":"Individual","region":"TIDEWATER","aligned":"","ano":"757\/865-3450","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/964-7630","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I25.10","R94.30","R51.","I10.","I48.91","Z79.899","E11.9","F03.90","E55.9","E78.5","E13.620","E66.01","I42.9","Z11.59","Z68.41","Z12.31","Z80.3","I34.0","I25.2","E78.00","Z95.5","Z79.01","Z79.84","Z79.82","Z88.1","Z88.8","Z87.891","Z82.49","Z83.3","R60.0","Z88.2","R94.31","I48.0","Z12.11","I25.119","E11.69","E11.59","E75.6","I15.2"],"date":["2021-05-24","2021-05-24","2020-09-29","2021-08-17","2021-08-17","2020-11-02","2021-08-17","2020-09-29","2021-02-04","2021-08-17","2021-04-13","2021-04-13","2021-04-13","2021-08-10","2021-04-13","2020-08-28","2020-08-28","2020-11-02","2020-11-02","2020-11-02","2020-11-02","2020-11-02","2020-11-02","2020-11-02","2020-11-02","2020-11-02","2020-11-02","2020-11-02","2020-11-02","2020-10-13","2020-10-01","2020-10-01","2021-05-24","2021-05-23","2021-08-17","2021-08-17","2021-08-17","2021-08-17","2021-08-17"],"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":[["","29300013601","CLONIDINE","0.2MG","60","Select","Select",""],["","68645049554","ATORVASTATIN","80MG","30","Select","Select",""],["","00781207401","TRIAMT\/HCTZ","37.5-25","30","Select","Select",""],["","68645019059","METOPROL","50MG","30","Select","Select",""],["","00591090030","GLIPIZIDE","2.5MG","30","Select","Select",""],["","49035015712","EQ","325MG","30","Select","Select",""],["","00597036082","PRADAXA","150MG","-60","Select","Select",""],["","00003089421","ELIQUIS","5MG","60","Select","Select",""],["","50458057990","XARELTO","20MG","30","Select","Select",""],["","80777027399","MODERNA","COVID-19","0","Select","Select",""],["","51672131003","AUG","0.05%","-50","Select","Select",""],["","43598043611","NITROGLYCERN","0.4MG","100","Select","Select",""],["","31604002585","VITAMIN","2000UNIT","90","Select","Select",""],["","00781207401","TRIAMT\/HCTZ ","37.5-25","30","Select","Select",""],["","68645019059","METOPROL ","50MG","90","Select","Select",""],["","29300013601","CLONIDINE ","0.2MG","60","Select","Select",""],["","68645049554","ATORVASTATIN ","80MG","30","Select","Select",""],["","00591090030","GLIPIZIDE ","2.5MG","30","Select","Select",""],["","49035041690","EQ ","325MG","90","Select","Select",""],["","50458057990","XARELTO ","20MG","30","Select","Select",""],["","00597036082","PRADAXA ","150MG","60","Select","Select",""],["","00003089421","ELIQUIS ","5MG","60","Select","Select",""],["","31604002585","VITAMIN ","2000UNIT","90","Select","Select",""],["","80777027399","MODERNA ","COVID-19","0","Select","Select",""],["","51672131001","AUG ","0.05%","-50","Select","Select",""],["","43598043611","NITROGLYCERN ","0.4MG","-100","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":""}]}]}