{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KEVIN   DELANDO JORDAN","gend":0,"add":"721 LAKE EDWARD DR APT 202","city":"VIRGINIA BEACH","state":"VA","zip":"23462-9998","dob":"1971-02-28","age":"","mstatus":"","insh":"5842166*01","cliId":"","pno":"414\/248-5269","cno":"414\/248-5269","email":"","ename":"","eno":"","pphy":"REED, SHARON B MD","ppno":"757\/622-8358","pcpadd":"930 W 21ST ST SUITE 100","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23517,"pcpcounty":"","pcpid":156143,"pcpname":"","plan":"OHP","program":"ACA","lob":"Individual","region":"TIDEWATER","aligned":"","ano":"757\/472-6157","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/622-9662","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["B20.","M25.561","M25.571","M79.89","N17.9","R11.2","R19.7","E87.6","E87.1","I10.","E78.5","U07.1","G62.9","M71.21","Z79.899","Z87.891","M25.461","M26.609","E86.0","F17.210","Z87.01","Z82.49","Z11.59","Z03.818","Z00.00","E11.9"],"date":["2021-07-20","2020-02-10","2020-02-10","2020-02-10","2020-07-27","2020-07-27","2020-07-27","2020-07-27","2020-07-27","2021-07-20","2020-07-27","2020-07-26","2020-02-10","2020-02-10","2020-07-26","2020-02-10","2020-02-10","2020-02-13","2020-07-26","2020-07-26","2020-07-26","2020-07-26","2020-08-11","2020-08-11","2021-07-14","2021-07-14"],"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":[["","52817036100","METOPROL","50MG","-60","Select","Select",""],["","00143913005","GEMFIBROZIL","600MG","60","Select","Select",""],["","65862047099","LOSARTAN\/HCT","100-25","30","Select","Select",""],["","15584010101","ATRIPLA","","30","Select","Select",""],["","31722070210","LOSARTAN","100MG","-90","Select","Select",""],["","29300012810","HYDROCHLOROT","25MG","-90","Select","Select",""],["","00093523456","EFAVIR\/EMTRI","TENOFOVI","-30","Select","Select",""],["","33342006410","VALSARTAN","160MG","90","Select","Select",""],["","88888888887","DMR","","1","Select","Select",""],["","59267100002","PFIZER","COVID-19","0","Select","Select",""],["","62332005090","LOSARTAN\/HCT ","100-25","30","Select","Select",""],["","75834013105","GEMFIBROZIL ","600MG","60","Select","Select",""],["","65862006399","METOPROL ","50MG","60","Select","Select",""],["","15584010101","ATRIPLA ","","-30","Select","Select",""],["","31722070210","LOSARTAN ","100MG","90","Select","Select",""],["","29300012810","HYDROCHLOROT ","25MG","90","Select","Select",""],["","00378581477","VALSARTAN ","160MG","-30","Select","Select",""],["","88888888887","DMR ","","1","Select","Select",""],["","00093523456","EFAVIR\/EMTRI ","TENOFOVI","30","Select","Select",""],["","59267100002","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":[[["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":""}]}]}