{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"STEVEN   E RANDALL SR","gend":0,"add":"71 DESMONDE LN","city":"WILLIAMSBURG","state":"VA","zip":"23185-9998","dob":"1950-09-28","age":"","mstatus":"","insh":"900041010*01","cliId":"","pno":"757\/291-5590","cno":"","email":"","ename":"","eno":"","pphy":"HOAG, THOMAS B DO","ppno":"757\/345-2071","pcpadd":"STE 201 5424 DISCOVERY PARK BLVD","pcpcity":"WILLIAMSBURG","pcpstate":"VA","pcpzip":23188,"pcpcounty":"","pcpid":"","pcpname":"DISCOVERY PARK FAMILY MEDICINE","plan":"OHP","program":"MEDICARE","lob":"MA-Non DSNP","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/903-4877","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R09.02","U07.1","J12.82","I10.","E78.2","E23.0","E11.65","Z12.11","J18.9","J98.4","R07.9","R05.","Z00.01","R97.20","J96.01","J84.9","J45.909","E66.3","Z68.31","E78.5","Z79.84","Z79.899","R06.02","E11.00","C61.","R79.89","Z20.828","J00.","H10.33","R05.9","R09.81","Z20.822","Z11.59"],"date":["2021-01-25","2021-02-04","2021-01-25","2022-02-24","2022-02-24","2022-02-24","2022-02-24","2022-05-28","2021-01-22","2021-01-22","2021-01-22","2021-01-22","2021-02-04","2021-09-02","2021-01-22","2021-01-22","2021-01-22","2021-01-22","2021-01-22","2021-01-22","2021-01-22","2021-01-22","2021-01-24","2021-01-25","2022-10-21","2021-01-21","2022-06-08","2021-10-31","2022-08-22","2022-08-22","2022-08-22","2022-08-22","2022-03-12"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}}]},{"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":[]},{"a":[]},{"a":{"indx":[false,false],"comment":["",""],"score":["",""]}},{"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":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","08290236712","LACTINEX","GRA ","60","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","18","Select","Select",""],["","31722071101","SILDENAFIL","TAB 100MG","6","Select","Select",""],["","00093727256","PIOGLITAZONE","TAB 30MG","90","Select","Select",""],["","00093505698","ATORVASTATIN","TAB 10MG","90","Select","Select",""],["","69543012450","GLIMEPIRIDE","TAB 2MG","180","Select","Select",""],["","08396903500","RELION","MIS 32GX5\/32","200","Select","Select",""],["","00536667101","ZINC","TAB 50MG","30","Select","Select",""],["","00002879959","HUMALOG","INJ 100\/ML","15","Select","Select",""],["","68645058259","METFORMIN","TAB 500MG","180","Select","Select",""],["","00088502005","LANTUS","INJ 100\/ML","15","Select","Select",""],["","63304061650","DOXYCYC","CAP 100MG","14","Select","Select",""],["","42806071401","BENZONATATE","CAP 100MG","12","Select","Select",""],["","53191024401","VITAMIN","CAP 5000UNIT","30","Select","Select",""],["","08290320550","BD  PEN NEEDL","MIS 32GX5\/32","-200","Select","Select",""],["","69238110002","DOXYCYCL","CAP 100MG","20","Select","Select",""],["","16714047802","AMOX\/K","TAB 875-125","14","Select","Select",""],["","57237002801","AMOXICILLIN","TAB 500MG","22","Select","Select",""],["","68382013201","TAMSULOSIN","CAP 0.4MG","90","Select","Select",""],["","16714007501","TADALAFIL","TAB 5MG","30","Select","Select",""],["","00132020145","FLEET","ENE ","133","Select","Select",""],["","58657067650","CIPROFLOXACN","TAB 500MG","3","Select","Select",""],["","49281012165","FLUZONE","INJ 2021-22","1","Select","Select",""],["","52244001002","EDEX","KIT 10MCG","1","Select","Select",""],["","60432060416","PROMETHAZINE","SYP DM","118","Select","Select",""],["","24208067004","SULFACET","SOL 10% OP","15","Select","Select",""]]}},{"a":[]},{"a":[]},{"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":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"comment":[["","","",""],[""],[""],[""],[""],[""]],"sub":[]}}},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":[]}]},{"t":"Mini-Cog","q":[{"a":[]},{"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":"","a13":""}]}]}