{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ROBERT   S WILSON","gend":0,"add":"2801 MANNING ROAD","city":"SUFFOLK","state":"VA","zip":"23434-9998","dob":"1961-11-20","age":"","mstatus":"","insh":"2173869*01","cliId":"","pno":"757\/539-5324","cno":"757\/539-5324","email":"","ename":"","eno":"","pphy":"JONES, SHAVON C MD","ppno":"757\/925-1866","pcpadd":"157 N MAIN ST","pcpcity":"SUFFOLK","pcpstate":"VA","pcpzip":23434,"pcpcounty":"","pcpid":116807,"pcpname":"","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":["I25.10","Z95.5","E78.5","I25.810","I10.","K21.9","K76.0","Z86.010","R94.31","Z01.810"],"date":["2021-04-26","2020-09-16","2021-04-26","2020-09-08","2021-04-26","2020-05-04","2020-05-04","2020-05-04","2020-08-06","2021-04-26"],"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":[["","60505258009","ATORVASTATIN ","40MG","30","Select","Select",""],["","68382009301","CARVEDILOL ","6.25MG","60","Select","Select",""],["","31722071390","PANTOPRAZOLE ","40MG","60","Select","Select",""],["","55111019690","CLOPIDOGREL ","75MG","30","Select","Select",""],["","68462063945","NITROGLYCERN ","0.4MG","25","Select","Select",""],["","00143924920","AMOX\/K ","875-125","20","Select","Select",""],["","00093310953","AMOXICILLIN ","500MG","30","Select","Select",""],["","72647033104","METHYLPRED ","4MG","21","Select","Select",""],["","65162011510","HYDROCO\/APAP ","7.5-325","7","Select","Select",""],["","65162046650","IBUPROFEN ","800MG","30","Select","Select",""],["","00116200116","CHLORHEX ","0.12%","473","Select","Select",""],["","31722071390","PANTOPRAZOLE","40MG","60","Select","Select",""],["","68382009301","CARVEDILOL","6.25MG","60","Select","Select",""],["","60505258009","ATORVASTATIN","40MG","30","Select","Select",""],["","68462063945","NITROGLYCERN","0.4MG","25","Select","Select",""],["","55111019690","CLOPIDOGREL","75MG","30","Select","Select",""],["","72647033104","METHYLPRED","4MG","21","Select","Select",""],["","65162011510","HYDROCO\/APAP","7.5-325","7","Select","Select",""],["","65162046650","IBUPROFEN","800MG","30","Select","Select",""],["","00116200116","CHLORHEX","0.12%","473","Select","Select",""],["","57237002801","AMOXICILLIN","500MG","21","Select","Select",""],["","00143924920","AMOX\/K","875-125","20","Select","Select",""],["","69238115403","EZETIMIBE ","TAB 10MG","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":""}]}]}