{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JACK WRIGHT","gend":0,"add":"78 RIDGE ROAD","city":"POQUOSON","state":"VA","zip":"23662-9998","dob":"1958-10-25","age":"","mstatus":"","insh":"4834968*01","cliId":"","pno":"757\/285-9334","cno":"757\/285-9334","email":"","ename":"","eno":"","pphy":"KHANNA, SIDDHARTH MD","ppno":"757\/868-7709","pcpadd":"370A WYTHE CREEK ROAD","pcpcity":"POQUOSON","pcpstate":"VA","pcpzip":23662,"pcpcounty":"","pcpid":168390,"pcpname":"MARYVIEW HOSPITALISTS","plan":"OHP","program":"ACA","lob":"Individual","region":"TIDEWATER","aligned":"","ano":"757\/285-9334","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":["G47.33","I08.0","M25.552","G89.29","R06.00","I11.0","I50.22","M16.0","R79.89","E66.9","R01.1","Z79.82","Z79.899","R06.02","I50.32","R06.09","E11.9","R63.5","M21.70","M16.12","Z96.652","Z11.59","Z00.00","Z23.","E78.2","M1A.09X0","E55.9","I35.0","I34.0","I49.1","I49.3","M25.551","Z12.11","F17.200","I10.","M19.90","Z20.828","L72.3","L98.9","R22.2"],"date":["2021-07-08","2020-01-24","2020-07-21","2020-07-21","2020-06-06","2020-11-05","2020-06-06","2020-07-02","2020-06-06","2021-07-08","2020-06-06","2020-06-06","2020-06-06","2020-06-06","2020-11-05","2020-01-13","2021-09-09","2020-04-22","2020-06-09","2020-07-21","2020-08-13","2020-08-18","2020-11-05","2020-11-05","2021-09-09","2020-11-05","2020-11-05","2021-09-09","2020-01-13","2020-01-13","2020-01-13","2020-06-09","2021-05-23","2021-07-08","2021-09-09","2021-07-08","2020-11-24","2021-09-09","2021-10-18","2021-10-18"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",null,null]}},{"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":[["","16729013501","ALLOPURINOL","300MG","30","Select","Select",""],["","00054429931","FUROSEMIDE","40MG","30","Select","Select",""],["","31722070290","LOSARTAN","100MG","30","Select","Select",""],["","67877019905","AMLODIPINE","10MG","31","Select","Select",""],["","00093720198","PRAVASTATIN","20MG","30","Select","Select",""],["","00093310953","AMOXICILLIN","500MG","-20","Select","Select",""],["","27808015701","ROSUVASTATIN","20MG","30","Select","Select",""],["","65162071009","COLCHICINE","0.6MG","60","Select","Select",""],["","67877056105","METFORMIN","500MG","60","Select","Select",""],["","69543025216","VIRTUSSIN","100-10\/5","240","Select","Select",""],["","00093720198","PRAVASTATIN ","20MG","30","Select","Select",""],["","67877019905","AMLODIPINE ","10MG","31","Select","Select",""],["","00054429931","FUROSEMIDE ","40MG","30","Select","Select",""],["","31722070290","LOSARTAN ","100MG","30","Select","Select",""],["","16729013501","ALLOPURINOL ","300MG","30","Select","Select",""],["","69543025216","VIRTUSSIN ","100-10\/5","240","Select","Select",""],["","00093310953","AMOXICILLIN ","500MG","-20","Select","Select",""],["","65162071009","COLCHICINE ","0.6MG","60","Select","Select",""],["","27808015701","ROSUVASTATIN ","20MG","30","Select","Select",""],["","67877056105","METFORMIN ","500MG","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":""}]}]}