{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DAVID   J NIEMI","gend":0,"add":"3004 MAYON DR","city":"CHESAPEAKE","state":"VA","zip":"23325-9998","dob":"1961-01-16","age":"","mstatus":"","insh":"3243338*01","cliId":"","pno":"757\/775-6292","cno":"757\/775-6292","email":"","ename":"","eno":"","pphy":"LIGHT, RYAN E MD","ppno":"757\/389-5370","pcpadd":"STE 100 1100 VOLVO PKWY","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":23320,"pcpcounty":"","pcpid":170690,"pcpname":"GREENBRIER FAMILY MEDICINE","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"757\/879-0853, ","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/389-5381","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z01.811","M17.11","Z01.812","Z01.818","M17.9","I10.","Z47.1","Z96.651","F17.200","K21.9","Z79.82","Z86.73","M25.473","L30.9","Z68.38","E83.110","Z86.79","D75.1","G89.18","M25.561","D72.829","E66.9","M17.0","M16.11","F17.210","Z23.","Z79.899","Z98.890","Z01.810","M71.21","M25.461","M25.471","M25.562","M62.81","R26.89","Z20.828"],"date":["2020-02-17","2020-07-07","2020-02-17","2020-03-24","2020-03-03","2020-05-12","2020-03-10","2020-07-07","2020-05-12","2020-03-10","2020-03-10","2020-03-10","2020-05-12","2020-05-12","2020-05-12","2021-08-17","2020-02-17","2021-08-17","2020-03-02","2020-04-01","2021-02-03","2021-02-03","2020-03-24","2020-02-21","2020-03-02","2020-03-02","2020-03-02","2020-04-01","2020-02-17","2020-02-21","2020-02-21","2020-02-21","2020-03-24","2020-03-24","2020-03-24","2021-08-20"],"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":[["","65862056090","PANTOPRAZOLE","40MG","30","Select","Select",""],["","68180072003","AMLODIPINE","5MG","30","Select","Select",""],["","00406055201","OXYCODONE","5MG","40","Select","Select",""],["","65162024709","CHLORTHALID","25MG","30","Select","Select",""],["","00069047103","CHANTIX","0.5& 1MG","-53","Select","Select",""],["","43547033710","BENAZEPRIL","20MG","30","Select","Select",""],["","65862090801","CELECOXIB","100MG","60","Select","Select",""],["","00363041414","ASPIRIN","81MG EC","60","Select","Select",""],["","51672127003","DESOXIMETAS","0.25%","60","Select","Select",""],["","00363051908","PAIN","500MG\/RR","100","Select","Select",""],["","67618010110","COLACE","100MG","60","Select","Select",""],["","59267100001","PFIZER","COVID-19","0","Select","Select",""],["","43547033710","BENAZEPRIL ","20MG","30","Select","Select",""],["","65162024709","CHLORTHALID ","25MG","30","Select","Select",""],["","65862056090","PANTOPRAZOLE ","40MG","30","Select","Select",""],["","00363058714","ASPIRIN ","81MG EC","60","Select","Select",""],["","65862090801","CELECOXIB ","100MG","60","Select","Select",""],["","00363051908","PAIN ","500MG\/RR","100","Select","Select",""],["","00406055201","OXYCODONE ","5MG","40","Select","Select",""],["","67618010110","COLACE ","100MG","60","Select","Select",""],["","68180072003","AMLODIPINE ","5MG","30","Select","Select",""],["","51672127003","DESOXIMETAS ","0.25%","60","Select","Select",""],["","00069047103","CHANTIX ","0.5& 1MG","53","Select","Select",""],["","59267100001","PFIZER ","COVID-19","0","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","",""],["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":""}]}]}