{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CHRISTOPHER   A MASARELLA","gend":0,"add":"26218 REAMS DR","city":"PETERSBURG","state":"VA","zip":"23805-9998","dob":"1976-02-03","age":"","mstatus":"","insh":"2150762*01","cliId":"","pno":"804\/586-8931","cno":"804\/586-8931","email":"","ename":"","eno":"","pphy":"RUSSELL, AMANDA MD","ppno":"804\/469-3731","pcpadd":"13855 COURTHOUSE ROAD","pcpcity":"DINWIDDIE","pcpstate":"VA","pcpzip":23841,"pcpcounty":"","pcpid":112325,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/469-5307","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z20.828","R05.","R50.9","I25.119","I25.2","R00.1","E78.5","F90.9","J45.909","F17.210","R94.31","Z95.5","H43.393","H04.123","H52.03","Z11.59","G47.00","F17.211"],"date":["2020-04-14","2020-04-14","2020-04-14","2020-03-09","2020-03-09","2020-03-09","2020-03-09","2020-03-09","2020-03-09","2020-03-09","2020-03-09","2020-03-09","2021-07-09","2021-07-09","2021-07-09","2020-09-14","2021-06-02","2021-06-02"],"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":[["","66993058597","FLUTIC\/SALME ","250\/50","60","Select","Select",""],["","00093317431","ALBUTEROL ","HFA","8","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","59762330403","NITROGLYCERN ","0.4MG","25","Select","Select",""],["","16729004517","ATORVASTATIN ","20MG","30","Select","Select",""],["","00591247501","TETRACYCLINE ","500MG","56","Select","Select",""],["","50111033301","METRONIDAZOL ","250MG","56","Select","Select",""],["","00069046903","CHANTIX ","1MG","56","Select","Select",""],["","42571025101","CLINDAMYCIN ","150MG","28","Select","Select",""],["","60505476606","APO-VARENICL ","1MG","56","Select","Select",""],["","00173069600","ADVAIR ","250\/50","60","Select","Select",""],["","65162046650","IBUPROFEN ","800MG","20","Select","Select",""],["","55111015810","OMEPRAZOLE ","20MG","60","Select","Select",""],["","68382080510","TRAZODONE ","50MG","30","Select","Select",""],["","66993058597","FLUTIC\/SALME","250\/50","60","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","16729004517","ATORVASTATIN","20MG","30","Select","Select",""],["","59762330403","NITROGLYCERN","0.4MG","25","Select","Select",""],["","00591247501","TETRACYCLINE","500MG","56","Select","Select",""],["","00093317431","ALBUTEROL","HFA","8","Select","Select",""],["","00069046903","CHANTIX","1MG","56","Select","Select",""],["","42571025101","CLINDAMYCIN","150MG","28","Select","Select",""],["","65162046650","IBUPROFEN","800MG","20","Select","Select",""],["","00173069600","ADVAIR","250\/50","60","Select","Select",""],["","68382080510","TRAZODONE","50MG","30","Select","Select",""],["","55111015810","OMEPRAZOLE","20MG","60","Select","Select",""],["","60505476606","APO-VARENICL","1MG","56","Select","Select",""],["","59267100002","PFIZER","COVID-19","0","Select","Select",""],["","50111033301","METRONIDAZOL","250MG","56","Select","Select",""],["","59267100002","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":[[["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":""}]}]}