{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DWAYNE   S KING","gend":0,"add":"2518 BEAUFORT AVE","city":"VIRGINIA BEACH","state":"VA","zip":"23455-9998","dob":"1963-04-18","age":"","mstatus":"","insh":"7099746*01","cliId":"","pno":"757\/620-5869","cno":"757\/620-5869","email":"","ename":"","eno":"","pphy":"ATWOOD, RONALD W MD","ppno":"757\/436-1234","pcpadd":"SUITE 100 108 KNELLS RIDGE BLVD","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":23320,"pcpcounty":"","pcpid":101400,"pcpname":"Atwood Family Medical Center","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/548-3665","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R51.9","R44.1","H53.9","I10.","R10.13","R11.2","K82.4","K76.0","Z00.00","Z13.0","Z13.220","Z12.12","E55.9","Z12.5","R94.5","K82.8","G43.119","R53.1","Z01.818","K81.1","Z23.","Z79.899","F17.200","Z87.19","Z86.59","Z88.8","F17.210","R53.83","R73.01","R23.8","R45.86","H10.13","F41.1"],"date":["2020-12-15","2020-12-02","2021-07-15","2021-08-10","2020-12-02","2020-12-02","2021-01-27","2020-12-22","2021-02-09","2021-02-09","2021-02-09","2021-02-09","2021-02-09","2021-02-09","2021-02-09","2021-01-27","2021-03-08","2020-12-15","2021-01-07","2021-01-27","2020-12-04","2021-01-27","2021-01-27","2021-01-27","2021-01-27","2021-01-27","2021-02-09","2021-07-15","2021-07-15","2021-07-15","2021-09-03","2021-09-03","2021-09-22"],"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":[["","45963067711","METOPROL","100MG ER","90","Select","Select",""],["","68382000514","TOPIRAMATE","25MG","-120","Select","Select",""],["","00023650110","UBRELVY","100MG","10","Select","Select",""],["","58160088552","FLUARIX","2020-21","0","Select","Select",""],["","45963067611","METOPROLOL","50MG ER","30","Select","Select",""],["","31722088390","ROSUVASTATIN","10MG","90","Select","Select",""],["","00406055201","OXYCODONE","5MG","28","Select","Select",""],["","45963067711","METOPROL ","100MG ER","90","Select","Select",""],["","58160088552","FLUARIX ","2020-21","0","Select","Select",""],["","45963067611","METOPROLOL ","50MG ER","30","Select","Select",""],["","00406055201","OXYCODONE ","5MG","28","Select","Select",""],["","68382000514","TOPIRAMATE ","25MG","-20","Select","Select",""],["","00023650110","UBRELVY ","100MG","10","Select","Select",""],["","31722088390","ROSUVASTATIN ","10MG","-90","Select","Select",""],["","68180072103","AMLODIPINE ","10MG","90","Select","Select",""],["","68180072103","AMLODIPINE","10MG","90","Select","Select",""],["","61874011530","VRAYLAR","1.5MG","30","Select","Select",""],["","60219175303","SILDENAFIL","100MG","4","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":""}]}]}