{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JAMES   A BALES","gend":0,"add":"15 FERGUSON ST","city":"POQUOSON","state":"VA","zip":"23662-9998","dob":"1964-03-20","age":"","mstatus":"","insh":"8137595*01","cliId":"","pno":"757\/715-7555","cno":"757\/715-7555","email":"","ename":"","eno":"","pphy":"ROBESON, THOMAS N MD","ppno":"757\/873-2000","pcpadd":"STE 700 704 THIMBLE SHOALS","pcpcity":"NEWPORT NEWS","pcpstate":"VA","pcpzip":23606,"pcpcounty":"","pcpid":660033,"pcpname":"Oyster Point Family Practice","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/873-2003","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R59.1","W57.XXXA","L81.9","L90.5","Z23.","D48.5","J06.9","R55.","R42.","E78.00","D22.5","Z48.02","Z71.9","L95.9","L82.1","D18.00","D22.9","L81.4","Z00.00","Z12.5","L40.9","Z85.820","Z12.83","Z12.11"],"date":["2020-05-18","2020-05-18","2020-05-22","2021-03-23","2020-12-03","2021-03-08","2020-01-23","2020-10-27","2020-10-27","2020-10-27","2021-03-16","2021-03-16","2021-03-16","2020-04-16","2021-03-02","2021-03-02","2021-03-02","2021-03-02","2021-02-16","2021-02-16","2021-03-02","2021-03-02","2021-03-02","2020-08-31"],"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":[["","00143924920","AMOX\/K ","875-125","10","Select","Select",""],["","69238110005","DOXYCYCL ","100MG","14","Select","Select",""],["","65862039010","ONDANSETRON ","4MG ODT","24","Select","Select",""],["","00168026760","AUG ","0.05%","-60","Select","Select",""],["","80777027399","MODERNA ","COVID-19","0","Select","Select",""],["","00143924920","AMOX\/K","875-125","10","Select","Select",""],["","69238110005","DOXYCYCL","100MG","14","Select","Select",""],["","65862039010","ONDANSETRON","4MG ODT","24","Select","Select",""],["","00168026760","AUG","0.05%","60","Select","Select",""],["","80777027399","MODERNA","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":[[["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":""}]}]}