{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"GERALD   R GREENE JR","gend":0,"add":"3417 BOW CREEK BLVD","city":"VIRGINIA BEACH","state":"VA","zip":"23452-9998","dob":"1974-12-19","age":"","mstatus":"","insh":"8298564*01","cliId":"","pno":"757\/277-3964","cno":"757\/277-3964","email":"","ename":"","eno":"","pphy":"SUN, TOMMY MD","ppno":"757\/507-0305","pcpadd":"STE 300 1950 GLENN MITCHELL","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23456,"pcpcounty":"","pcpid":140395,"pcpname":"SMG - Sentara Family Medicine Physicians - Princess Anne","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/507-0306","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K22.70","K21.0","Z86.010","R63.4","F17.210","K76.0","E27.9","K22.8","M54.12","Z12.11","D12.3","D12.4","K57.30","Z98.0","K44.9","K63.5","F17.200","K40.20","D12.6","Z12.5","Z00.00"],"date":["2020-09-23","2020-09-23","2020-11-17","2020-11-24","2020-11-24","2020-11-24","2020-11-24","2020-03-06","2020-03-04","2020-11-17","2020-11-17","2020-11-17","2020-11-17","2020-11-17","2020-03-06","2020-11-17","2020-11-24","2020-11-24","2020-11-17","2020-11-05","2020-11-05"],"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":[["","55111015930","OMEPRAZOLE","40MG","30","Select","Select",""],["","68462029817","CLOTRIM\/BETA","DIPROP","45","Select","Select",""],["","55111015930","OMEPRAZOLE ","40MG","30","Select","Select",""],["","68462029817","CLOTRIM\/BETA ","DIPROP","45","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","",""],["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":""}]}]}