{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JAMES   W ADAMS","gend":0,"add":"10 MAC ALVA DR","city":"HAMPTON","state":"VA","zip":"23669-9998","dob":"1975-01-24","age":"","mstatus":"","insh":"7308779*01","cliId":"","pno":"239-0744","cno":"239-0744","email":"","ename":"","eno":"","pphy":"MCCORMICK, BRIAN C MD","ppno":"757\/838-6335","pcpadd":"STE A 9 MANHATTAN SQ","pcpcity":"HAMPTON","pcpstate":"VA","pcpzip":23666,"pcpcounty":"","pcpid":410067,"pcpname":"Hampton Family Practice, PLLC","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"722-7978","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/838-0612","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z79.899","L40.0","E11.65","Z20.828","M62.830"],"date":["2020-02-27","2021-01-14","2020-05-01","2021-02-19","2020-11-24"],"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":[["","57894006103","STELARA ","90MG\/ML","-1","Select","Select",""],["","13668001001","CITALOPRAM ","20MG","90","Select","Select",""],["","42806031505","METFORMIN ","1000MG","180","Select","Select",""],["","00173060002","FLOVENT ","50MCG","60","Select","Select",""],["","00074204202","SKYRIZI ","150DOSE","-1","Select","Select",""],["","53885044801","ONETOUCH ","ULTRA 2","1","Select","Select",""],["","11822370590","RA ","WIPES","100","Select","Select",""],["","76385012350","METHOCARBAM ","500MG","40","Select","Select",""],["","57894006103","STELARA","90MG\/ML","-1","Select","Select",""],["","42806031505","METFORMIN","1000MG","180","Select","Select",""],["","00173060002","FLOVENT","50MCG","-60","Select","Select",""],["","13668001001","CITALOPRAM","20MG","90","Select","Select",""],["","00074204202","SKYRIZI","150DOSE","-1","Select","Select",""],["","11822370590","RA","WIPES","100","Select","Select",""],["","53885044801","ONETOUCH","ULTRA 2","1","Select","Select",""],["","76385012350","METHOCARBAM","500MG","40","Select","Select",""],["","00406996201","TEMAZEPAM ","CAP 30MG","30","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","",""],["No","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":""}]}]}