{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" CHERI W HARVEY","gend":1,"add":"7705 ROANOKE AVE","city":"NEWPORT NEWS","state":"VA","zip":"23605-9998","dob":"1962-03-25","age":"","mstatus":"","insh":"3877574*01","cliId":"","pno":"757\/826-1005","cno":"757\/826-1005, 000\/000-0000","email":"","ename":"","eno":"","pphy":"JONES JR, SAMUEL MD","ppno":"757\/838-6335","pcpadd":"STE A 9 MANHATTAN SQ","pcpcity":"HAMPTON","pcpstate":"VA","pcpzip":"23666-9998","pcpcounty":"","pcpid":410067,"pcpname":"Hampton Family Practice, PLLC","plan":"OHP - OPTIMA","program":"ACA","lob":"Small Group","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":["Z12.11","E11.311","E11.65","Z11.59","Z20.828","Z00.00","I10.","E78.5","Z79.4","Z68.38","L30.9","H40.053","Z12.31","Z85.3","E11.3292","H00.021"],"date":["2020-10-14","2020-09-15","2021-05-19","2020-12-21","2020-12-21","2021-05-19","2021-05-19","2021-05-19","2021-05-19","2021-05-19","2021-03-22","2021-05-12","2020-12-24","2020-12-24","2020-01-22","2020-10-09"],"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":[["","13668011790","LOSARTAN\/HCT","100-12.5","30","Select","Select",""],["","31722070290","LOSARTAN","100MG","90","Select","Select",""],["","00002879759","HUMALOG","75\/25KWP","15","Select","Select",""],["","16729018201","HYDROCHLOROT","12.5MG","90","Select","Select",""],["","70010049201","METFORMIN","750MG ER","180","Select","Select",""],["","11822576450","PEN NEEDLES","31GX8MM","-100","Select","Select",""],["","53885027025","ONETOUCH","VERIO","100","Select","Select",""],["","08290320109","BD PEN NEEDL","31GX8MM","100","Select","Select",""],["","52565002215","ECONAZOLE","1%","-30","Select","Select",""],["","60505294509","EZETIMIBE","10MG","90","Select","Select",""],["","69315030805","CIPROFLOXACN","0.3% OP","5","Select","Select",""],["","00168000680","TRIAMCINOLON","0.10%","80","Select","Select",""],["","00002143380","TRULICITY","0.75\/0.5","-2","Select","Select",""],["","51672128103","DESONIDE","0.05%","60","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":""}]}]}