{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JUDY   WALKER MARTIN","gend":1,"add":"601 RUTHERFORD DR","city":"CHESAPEAKE","state":"VA","zip":"23322-9998","dob":"1959-06-08","age":"","mstatus":"","insh":"5618185*01","cliId":"","pno":"757\/482-7300","cno":"757\/482-7300","email":"","ename":"","eno":"","pphy":"SHAH, DHARMESH K MD","ppno":"757\/543-6861","pcpadd":"710 LIBERTY STREET","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":23324,"pcpcounty":"","pcpid":122310,"pcpname":"","plan":"OHP","program":"ACA","lob":"Individual","region":"TIDEWATER","aligned":"","ano":"757\/482-7300","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/543-4082","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N39.0","R81.","I10.","F31.9","E55.9","E78.2","F17.200","Z12.11","R51.","F32.9","Z87.891","J44.9","Z23.","F34.1"],"date":["2021-06-01","2021-06-01","2021-02-23","2021-09-24","2021-02-23","2021-09-24","2021-02-23","2021-05-23","2020-02-20","2020-02-20","2020-02-20","2020-07-13","2021-09-24","2021-09-24"],"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":[["","60505257809","ATORVASTATIN ","10MG","30","Select","Select",""],["","16714079701","SUMATRIPTAN ","50MG","6","Select","Select",""],["","00378235193","ESOMEPRA ","40MG DR","60","Select","Select",""],["","27241009903","DULOXETINE ","60MG","60","Select","Select",""],["","65862057490","MONTELUKAST ","10MG","30","Select","Select",""],["","64380073706","VITAMIN ","50000UNT","4","Select","Select",""],["","00832712411","DIVALPROEX ","500MG DR","270","Select","Select",""],["","13107007501","BUT\/APAP\/CAF ","","60","Select","Select",""],["","00591024110","LORAZEPAM ","1MG","60","Select","Select",""],["","69238112309","NADOLOL ","20MG","30","Select","Select",""],["","31722071390","PANTOPRAZOLE ","40MG","30","Select","Select",""],["","68382080701","TRAZODONE ","150MG","30","Select","Select",""],["","00254101196","SUCRALFATE ","1GM\/10ML","120","Select","Select",""],["","67877019805","AMLODIPINE ","5MG","30","Select","Select",""],["","59676058015","JANSSEN ","COVID-19","0","Select","Select",""],["","58657067601","CIPROFLOXACN ","500MG","6","Select","Select",""],["","60505257809","ATORVASTATIN","10MG","30","Select","Select",""],["","16714079701","SUMATRIPTAN","50MG","6","Select","Select",""],["","65862057490","MONTELUKAST","10MG","30","Select","Select",""],["","00378235193","ESOMEPRA","40MG DR","60","Select","Select",""],["","64380073706","VITAMIN","50000UNT","4","Select","Select",""],["","27241009903","DULOXETINE","60MG","60","Select","Select",""],["","00832712411","DIVALPROEX","500MG DR","90","Select","Select",""],["","00591024110","LORAZEPAM","1MG","60","Select","Select",""],["","13107007501","BUT\/APAP\/CAF","","60","Select","Select",""],["","69238112309","NADOLOL","20MG","30","Select","Select",""],["","68382080701","TRAZODONE","150MG","90","Select","Select",""],["","31722071390","PANTOPRAZOLE","40MG","90","Select","Select",""],["","00254101196","SUCRALFATE","1GM\/10ML","120","Select","Select",""],["","67877019805","AMLODIPINE","5MG","30","Select","Select",""],["","59676058015","JANSSEN","COVID-19","0","Select","Select",""],["","58657067601","CIPROFLOXACN","500MG","6","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":""}]}]}