{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LEO  M GALLE","gend":0,"add":"210 D ST","city":"CHESAPEAKE","state":"VA","zip":"23324-9998","dob":"1953-05-13","age":"","mstatus":"","insh":"20027642*01","cliId":"","pno":"757\/404-3035","cno":"757\/404-3035","email":"","ename":"","eno":"","pphy":"MUSSELMANI, ZATTAM MD","ppno":"757\/543-3557","pcpadd":"1422 POINDEXTER ST","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":23324,"pcpcounty":"","pcpid":119860,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/543-0053","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R97.20","C61.","Z79.01","E11.9","I10.","I25.10","I48.91","Z01.810","C44.40","E78.5"],"date":["2020-03-20","2020-11-16","2020-11-10","2020-08-18","2021-08-19","2021-08-19","2021-08-09","2021-08-09","2021-08-19","2021-08-19"],"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":[["","00093171210","WARFARIN ","1MG","30","Select","Select",""],["","68180046403","SIMVASTATIN ","40MG","30","Select","Select",""],["","00143124001","DIGOXIN ","0.125MG","30","Select","Select",""],["","00088222033","LANTUS ","100\/ML","10","Select","Select",""],["","68180098103","LISINOPRIL ","20MG","30","Select","Select",""],["","69315011710","FUROSEMIDE ","40MG","30","Select","Select",""],["","53746051110","SPIRONOLACT ","25MG","30","Select","Select",""],["","86227090105","INSULIN ","1ML\/29G","100","Select","Select",""],["","51991080510","METFORMIN ","500MG","60","Select","Select",""],["","55111028130","LEVOFLOXACIN ","750MG","1","Select","Select",""],["","68382009405","CARVEDILOL ","12.5MG","60","Select","Select",""],["","60505317007","OMEGA-3-ACID ","1GM","120","Select","Select",""],["","56151014260","TRUPLUS ","28G","100","Select","Select",""],["","54629001893","OMEGA-3 ","1000MG","120","Select","Select",""],["","53746010905","HYDROCO\/APAP ","5-325MG","20","Select","Select",""],["","67877021905","CEPHALEXIN ","500MG","15","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","",""],["Yes","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":""}]}]}