{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JOHN   T GROSS","gend":0,"add":"1 HILKE DR LOT 1","city":"HAMPTON","state":"VA","zip":"23666-9998","dob":"1962-03-19","age":"","mstatus":"","insh":"1347471*01","cliId":"","pno":"757\/265-4363","cno":"757\/265-4363","email":"","ename":"","eno":"","pphy":"YOUNGER, SARAH ANN MD","ppno":"757\/825-4273","pcpadd":"2205 EXECUTIVE DR SUITE D","pcpcity":"HAMPTON","pcpstate":"VA","pcpzip":23666,"pcpcounty":"","pcpid":172726,"pcpname":"FAMILY PRACTICE OF HAMPTON ROADS","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R42.","R39.89","R61.","Z82.49","R55.","I10.","R73.01","K21.00","E78.5","Z87.891","K43.9","L57.8","L82.1","L72.3","L81.4","D22.9","D18.01","M15.0","K21.9","M94.0","R07.9","C61.","R35.1","R35.0","Z00.00","M79.671","L21.9","L57.0","R00.1"],"date":["2021-07-26","2021-07-26","2021-07-26","2021-07-26","2021-08-26","2021-07-26","2021-07-26","2021-07-26","2021-07-26","2021-07-26","2020-07-11","2020-11-09","2020-11-09","2020-11-09","2020-11-09","2020-11-09","2020-11-09","2020-09-01","2020-09-01","2021-02-20","2021-02-20","2021-02-23","2021-02-23","2021-02-23","2021-05-03","2021-05-03","2020-02-07","2020-02-07","2021-08-26"],"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":[["","29300013601","CLONIDINE ","0.2MG","30","Select","Select",""],["","55111015901","OMEPRAZOLE ","40MG","30","Select","Select",""],["","31722070290","LOSARTAN ","100MG","30","Select","Select",""],["","67877019805","AMLODIPINE ","5MG","30","Select","Select",""],["","72647033104","METHYLPRED ","4MG","21","Select","Select",""],["","16571020110","DICLOFENAC ","75MG DR","60","Select","Select",""],["","50742061501","METOPROL ","25MG ER","90","Select","Select",""],["","67877019805","AMLODIPINE","5MG","30","Select","Select",""],["","31722070290","LOSARTAN","100MG","30","Select","Select",""],["","55111015901","OMEPRAZOLE","40MG","30","Select","Select",""],["","29300013601","CLONIDINE","0.2MG","30","Select","Select",""],["","16571020110","DICLOFENAC","75MG DR","60","Select","Select",""],["","72647033104","METHYLPRED","4MG","21","Select","Select",""],["","50742061501","METOPROL","25MG ER","90","Select","Select",""],["","11822030300","ACETAMIN ","TAB 500MG","50","Select","Select",""],["","00536105429","ASPIRIN ","TAB 325MG","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":[[["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Yes","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":""}]}]}