{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"L   REDNILECNERWAL ","gend":1,"add":" HSUOB 108203 ETS TS","city":"NORFOLK","state":"VA","zip":"23510-9998","dob":"1956-09-11","age":"","mstatus":"","insh":"04000910*972","cliId":"6VU4CK8QG89","pno":"26\/7571616-5","cno":"757\/625-6161","email":"","ename":"","eno":"","pphy":"GIBSON, AMANDA R MD","ppno":"757\/446-5955","pcpadd":"825 FAIRFAX AVE SUITE 118","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23507,"pcpcounty":"","pcpid":100070,"pcpname":"EVMS Ghent Family Medicine","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"TIDEWATER","aligned":"Y","ano":"Non-DSNP","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F41.9","F79.","E78.5","I10.","M85.80","Z13.0","R73.03","H40.1132","E11.9","B36.0","Z12.31","Z23.","Z00.00","Z13.31","H25.13","R73.09"],"date":["2021-09-27","2021-09-27","2021-09-20","2021-09-20","2021-09-20","2020-09-21","2020-12-21","2021-09-13","2021-10-11","2020-09-21","2021-02-01","2021-09-20","2020-12-21","2021-10-11","2021-09-13","2021-09-20"],"priorHcc":[null,null,null,null,null,"","",null,null,"","",null,"",null,null,null]}},{"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":[["","17478062512","LATANOPROST","SOL 0.00005","2","Select","Select",""],["","42543071290","LEVOCETIRIZI","TAB 5MG","30","Select","Select",""],["","68180098003","LISINOPRIL","TAB 10MG","90","Select","Select",""],["","29300013010","HYDROCHLOROT","CAP 12.5MG","90","Select","Select",""],["","16729000617","SIMVASTATIN","TAB 40MG","90","Select","Select",""],["","68382018201","BUSPIRONE","TAB 15MG","120","Select","Select",""],["","58160082311","SHINGRIX","INJ 50\/0.5ML","1","Select","Select",""],["","45802004064","SELENIUM SUL","LOT 0.025","120","Select","Select",""],["","63304062110","ATENOLOL","TAB 25MG","90","Select","Select",""],["","65162005703","RALOXIFENE","TAB 60MG","90","Select","Select",""],["","41167016515","SELSUN BLUE","SHA 0.01","325","Select","Select",""],["","42543071290","LEVOCETIRIZINE DIHYDROCHLORIDE","","30","Select","Select",""],["","93100305","BUSPIRONE HCL ","","90","Select","Select",""],["","65162005703","RALOXIFENE HYDROCHLORIDE","","90","Select","Select",""],["","45802004064","SELENIUM SULFIDE","","120","Select","Select",""],["","29300013010","HYDROCHLOROTHIAZIDE","","90","Select","Select",""],["","68382018205","BUSPIRONE HCL","","90","Select","Select",""],["","62756014202","METFORMIN HYDROCHLORIDE ER","500MG ER","90","Select","Select",""],["","17478062512","LATANOPROST                                                           ","SOL 0.00005","2","Select","Select",""],["","68382018205","BUSPIRONE HCL                                                         ","TAB 15MG","90","Select","Select",""],["","68180098003","LISINOPRIL                                                            ","TAB 10MG","90","Select","Select",""],["","42543071290","LEVOCETIRIZINE DIHYDROCHLORIDE                                        ","TAB 5MG","30","Select","Select",""],["","41167016515","SELSUN BLUE                                                           ","SHA 0.01","325","Select","Select",""],["","58160082311","SHINGRIX                                                              ","INJ 50\/0.5ML","1","Select","Select",""],["","63304062110","ATENOLOL                                                              ","TAB 25MG","90","Select","Select",""],["","16729000617","SIMVASTATIN                                                           ","TAB 40MG","90","Select","Select",""],["","65162005703","RALOXIFENE HYDROCHLORIDE                                              ","TAB 60MG","90","Select","Select",""],["","29300013010","HYDROCHLOROTHIAZIDE                                                   ","CAP 12.5MG","90","Select","Select",""],["","45802004064","SELENIUM SULFIDE                                                      ","LOT 0.025","120","Select","Select",""],["","62756014202","METFORMIN HYDROCHLORIDE ER                                            ","TAB 500MG ER","90","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","",""],["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["N\/A","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":""}]}]}