{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MALVERN   G GRIFFIN","gend":0,"add":"5517 TYPO LN","city":"NORFOLK","state":"VA","zip":"23502-9998","dob":"1956-06-25","age":"","mstatus":"","insh":"20028289*01","cliId":"","pno":"757\/352-1302","cno":"757\/352-1302","email":"","ename":"","eno":"","pphy":"CASTALDO, DAVID J MD","ppno":"757\/955-2828","pcpadd":"STE 320 885 KEMPSVILLE RD","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23502,"pcpcounty":"","pcpid":161929,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/955-2829","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R10.9","Z68.20","I46.9","T40.1X1A","F17.210","R62.7","C16.9","M25.511","R07.9","R14.3","F17.200","I25.10","J43.9","I25.2","I10.","Z85.028","Z90.49","Z98.84","C16.2","Z72.0","R07.89"],"date":["2020-01-20","2020-01-20","2020-07-08","2020-07-08","2020-07-08","2020-07-06","2020-07-06","2020-03-25","2020-03-25","2020-04-01","2020-04-01","2020-07-08","2020-07-08","2020-07-08","2020-07-08","2020-07-08","2020-07-08","2020-07-08","2020-05-13","2020-03-25","2020-03-25"],"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":[["","68382050010","OMEPRAZOLE ","40MG","30","Select","Select",""],["","65162062711","TRAMADOL ","50MG","60","Select","Select",""],["","00597007541","SPIRIVA ","HANDIHLR","30","Select","Select",""],["","70710122700","AMITRIPTYLIN ","50MG","30","Select","Select",""],["","00378932132","WIXELA ","250\/50","60","Select","Select",""],["","66993001968","ALBUTEROL ","HFA","18","Select","Select",""],["","00228202796","ALPRAZOLAM ","0.25MG","90","Select","Select",""],["","00173069700","ADVAIR ","500\/50","60","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","66993058697","FLUTIC\/SALME ","500\/50","60","Select","Select",""],["","00378001805","METOPROL ","25MG","15","Select","Select",""],["","00054327099","FLUTICASONE ","50MCG","32","Select","Select",""],["","00173068220","VENTOLIN ","","18","Select","Select",""],["","52817033010","CYCLOBENZAPR ","5MG","30","Select","Select",""],["","00536100410","ASPIRIN ","81MG EC","30","Select","Select",""],["","00406012305","HYDROCO\/APAP ","5-325MG","20","Select","Select",""],["","70010077001","METHOCARBAM ","750MG","90","Select","Select",""],["","70010077001","METHOCARBAM","750MG","90","Select","Select",""],["","66993058697","FLUTIC\/SALME","500\/50","60","Select","Select",""],["","00378001805","METOPROL","25MG","15","Select","Select",""],["","00597007541","SPIRIVA","HANDIHLR","60","Select","Select",""],["","70710122700","AMITRIPTYLIN","50MG","90","Select","Select",""],["","68382050010","OMEPRAZOLE","40MG","30","Select","Select",""],["","65162062711","TRAMADOL","50MG","60","Select","Select",""],["","00228202796","ALPRAZOLAM","0.25MG","90","Select","Select",""],["","00173069700","ADVAIR","500\/50","60","Select","Select",""],["","00378932232","WIXELA","500\/50","60","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","66993001968","ALBUTEROL","HFA","18","Select","Select",""],["","00054327099","FLUTICASONE","50MCG","32","Select","Select",""],["","00173068220","VENTOLIN","","18","Select","Select",""],["","52817033010","CYCLOBENZAPR","5MG","30","Select","Select",""],["","00406012305","HYDROCO\/APAP","5-325MG","20","Select","Select",""],["","00536100410","ASPIRIN","81MG EC","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","",""],["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":""}]}]}