{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"RHONDA   E NANGLE","gend":1,"add":"4917 PROVIDENCE RD","city":"VIRGINIA BEACH","state":"VA","zip":"23464-9998","dob":"1966-10-05","age":"","mstatus":"","insh":"5508517*01","cliId":"","pno":"757\/467-4185","cno":"757\/467-4185","email":"","ename":"","eno":"","pphy":"PHYSICIAN, PRIMARY CARE (MISC)","ppno":"","pcpadd":"4417 CORPORATION LN","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23462,"pcpcounty":"","pcpid":799999,"pcpname":"","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"757\/495-1004","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":["R10.13","R11.0","K22.8","K31.89","K63.5","Z12.11","K57.30","K64.1","K31.84","K21.9","K59.01","R14.2","E78.2","R73.01","J45.909","K58.9","M54.5","E66.9","K76.89","F33.9","F41.9","Z00.00","K21.00","K20.0","U07.1","Z23.","E11.9","L50.9"],"date":["2021-01-11","2021-06-09","2020-09-08","2020-09-08","2020-09-08","2020-09-08","2020-09-08","2020-09-08","2021-10-12","2021-06-09","2021-01-11","2021-01-11","2021-10-12","2021-10-12","2021-10-27","2020-04-27","2020-04-27","2020-04-27","2020-04-22","2021-10-12","2021-10-12","2021-09-15","2021-10-12","2021-10-12","2021-10-27","2021-10-27","2021-10-27","2021-11-12"],"priorHcc":["","","","","","","","",null,"","","",null,null,null,"","","","",null,null,null,null,null,null,null,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":[["","47335075983","VENLAFAXINE","75MG ER","90","Select","Select",""],["","68462010530","ONDANSETRON","4MG","30","Select","Select",""],["","49884068905","METOCLOPRAM","10MG","90","Select","Select",""],["","16729013716","CLONAZEPAM","1MG","60","Select","Select",""],["","55111012305","ATORVASTATIN","40MG","90","Select","Select",""],["","65649020175","MOVIPREP","","-1","Select","Select",""],["","69238148403","ERYTHROMYCIN","250MG BS","-180","Select","Select",""],["","62175011843","OMEPRAZOLE","20MG","180","Select","Select",""],["","00093720298","PRAVASTATIN","40MG","-90","Select","Select",""],["","55111012305","ATORVASTATIN ","40MG","90","Select","Select",""],["","47335075983","VENLAFAXINE ","75MG ER","90","Select","Select",""],["","16729013716","CLONAZEPAM ","1MG","60","Select","Select",""],["","49884068905","METOCLOPRAM ","10MG","90","Select","Select",""],["","68462010530","ONDANSETRON ","4MG","30","Select","Select",""],["","65649020175","MOVIPREP ","","1","Select","Select",""],["","62175011843","OMEPRAZOLE ","20MG","180","Select","Select",""],["","69238148403","ERYTHROMYCIN ","250MG BS","180","Select","Select",""],["","00093720298","PRAVASTATIN ","40MG","-90","Select","Select",""],["","69097014260","ALBUTEROL","HFA","7","Select","Select",""],["","00781808926","AZITHROMYCIN","250MG","6","Select","Select",""],["","00781808926","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","42806040021","METHYLPRED ","TAB 4MG","21","Select","Select",""],["","69097014260","ALBUTEROL ","AER HFA","7","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":""}]}]}