{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JAMES CARTWRIGHT","gend":0,"add":"9423 CHESAPEAKE ROAD","city":"NORFOLK","state":"VA","zip":"23503-9998","dob":"1972-05-29","age":"","mstatus":"","insh":"20025116*01","cliId":"","pno":7574895386,"cno":7578394536,"email":"","ename":"","eno":"","pphy":"FEE, ERIC MD","ppno":"757\/587-0157","pcpadd":"7924 CHESAPEAKE BLVD","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23518,"pcpcounty":"","pcpid":670139,"pcpname":"Bayview Medical Center","plan":"OHP","program":"MEDICAID","lob":"OHCC","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":["A41.9","E11.69","M86.472","E11.621","NO DATA","I96.","Z79.01","I42.0","L08.9","R26.81","R78.81","E13.69","B35.4","Z11.9","M86.9","R06.89","I50.9","L08.89","I50.22","I42.2","D64.9","R53.1","U07.1","Q20.3","N17.9","I50.42","I42.9","E86.0","R01.1","E11.9","I11.0","E78.00","E78.5","E66.09","Z89.432","Z79.899","Z88.8","R19.7","Z87.74"],"date":["2020-03-11","2020-01-27","2020-03-11","2020-01-27","2021-10-06","2020-03-11","2021-10-06","2020-04-11","2020-03-11","2020-03-11","2020-02-20","2020-02-20","2020-02-20","2020-02-20","2020-02-20","2021-02-22","2020-02-20","2020-03-02","2020-01-16","2020-01-16","2020-01-16","2021-10-06","2021-10-06","2021-10-06","2021-10-13","2021-10-06","2021-10-06","2021-10-06","2021-10-06","2021-10-06","2021-10-06","2021-10-06","2021-10-06","2021-10-06","2021-10-06","2021-10-06","2021-10-06","2021-10-06","2021-10-06"],"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":[["","00185012901","BUMETANIDE ","1MG","60","Select","Select",""],["","00093720198","PRAVASTATIN ","20MG","30","Select","Select",""],["","65862073260","AMIODARONE ","200MG","30","Select","Select",""],["","53746051101","SPIRONOLACT ","25MG","30","Select","Select",""],["","68180051303","LISINOPRIL ","5MG","30","Select","Select",""],["","59779030501","CLOTRIMAZOLE ","1%","14","Select","Select",""],["","00003089421","ELIQUIS ","5MG","60","Select","Select",""],["","76385011150","CARVEDILOL ","6.25MG","60","Select","Select",""],["","59779008001","ATHLETE ","1%","15","Select","Select",""],["","65862050320","AMOX\/K ","875-125","10","Select","Select",""],["","00185012901","BUMETANIDE","1MG","60","Select","Select",""],["","65862073260","AMIODARONE","200MG","30","Select","Select",""],["","76385011050","CARVEDILOL","3.125MG","60","Select","Select",""],["","00003089421","ELIQUIS","5MG","60","Select","Select",""],["","00093720198","PRAVASTATIN","20MG","30","Select","Select",""],["","53746051101","SPIRONOLACT","25MG","30","Select","Select",""],["","68180051303","LISINOPRIL","5MG","30","Select","Select",""],["","59779008001","ATHLETE","1%","15","Select","Select",""],["","59779030501","CLOTRIMAZOLE","1%","28","Select","Select",""],["","65862050320","AMOX\/K","875-125","10","Select","Select",""],["","59267100001","PFIZER ","INJ 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":[[["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["No","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":""}]}]}