{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" NEIL T MARTIN","gend":0,"add":"515 BURCHER RD","city":"NEWPORT NEWS","state":"VA","zip":"23606-9998","dob":"1961-07-18","age":"","mstatus":"","insh":"4430689*01","cliId":"","pno":"757\/870-7208","cno":"757\/870-7208, ","email":"","ename":"","eno":"","pphy":"LINDEMANN, CARL J MD","ppno":"757\/898-7261","pcpadd":"307 COOK RD","pcpcity":"YORKTOWN","pcpstate":"VA","pcpzip":"23690-9998","pcpcounty":"","pcpid":157501,"pcpname":"YORKTOWN FAMILY MEDICINE","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":["F41.8","S83.511A","M54.12","M79.661","R07.9","M25.561","Z68.26","Z12.11","R00.2","Z73.3","I82.4Y1","I82.411","I82.431","M79.662","M79.604","M79.89","I82.401","L71.8","I47.1","Z68.27","H00.15"],"date":["2021-06-15","2020-03-03","2020-05-20","2021-06-03","2021-04-28","2020-02-18","2020-08-11","2020-12-22","2020-12-22","2020-12-22","2020-07-20","2020-07-20","2020-07-20","2020-07-20","2020-07-20","2020-07-20","2020-12-22","2020-12-22","2020-12-22","2020-12-22","2020-03-06"],"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":[["","16571020110","DICLOFENAC","75MG DR","60","Select","Select",""],["","61314063136","NEO\/POLY\/DEX","0.1% OP","4","Select","Select",""],["","00378668977","PANTOPRAZOLE","40MG","-90","Select","Select",""],["","62332018030","TADALAFIL","20MG","15","Select","Select",""],["","59746000103","METHYLPRED","4MG","21","Select","Select",""],["","50458058451","XARELTO","15\/20MG","51","Select","Select",""],["","42806031250","DOXYCYCL","100MG","30","Select","Select",""],["","43547035110","LISINOPRIL","2.5MG","-30","Select","Select",""],["","16714001401","AMOX\/K","875-125","20","Select","Select",""],["","45802004064","SELENIUM","2.50%","120","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":""}]}]}