{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"   SILLYHPNNAMTTIW S","gend":1,"add":"NIE 3772RD NIETS","city":"VIRGINIA BEACH","state":"VA","zip":"23456-9998","dob":"1947-06-30","age":"","mstatus":"","insh":"24000910*930","cliId":"4MA8HY2RN39","pno":"27\/7576157-1","cno":"757\/721-7516","email":"","ename":"","eno":"","pphy":"REED, SHARON B MD","ppno":"757\/622-8358","pcpadd":"930 W 21ST ST SUITE 100","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23517,"pcpcounty":"","pcpid":156143,"pcpname":"","plan":"OHP","program":"MEDICARE","lob":"MA-NON DSNP","region":"TIDEWATER","aligned":"","ano":"","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":["H53.121","K31.89","K80.20","R07.9","J98.4"],"date":["2021-03-12","2021-07-16","2021-07-16","2021-07-16","2021-07-16"],"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":[["","75834015905","VERAPAMIL ","240MG ER","90","Select","Select",""],["","31722057330","ESOMEPRA ","40MG DR","90","Select","Select",""],["","63304044009","RISEDRON ","35MG DR","12","Select","Select",""],["","45802047264","HC ","2.5-1%","30","Select","Select",""],["","50742061610","METOPROL ","50MG ER","-90","Select","Select",""],["","69452015120","VITAMIN ","50000UNT","12","Select","Select",""],["","00173086910","ANORO ","62.5-25","180","Select","Select",""],["","13107008305","LORAZEPAM ","0.5MG","20","Select","Select",""],["","70377000812","ROSUVASTATIN ","20MG","90","Select","Select",""],["","50228014610","HYDROCHLOROT ","12.5MG","90","Select","Select",""],["","66993001968","ALBUTEROL ","HFA","18","Select","Select",""],["","050111033401","METRONIDAZOL ","500MG","30","Select","Select",""],["","072789011820","CIPROFLOXACN ","500MG","20","Select","Select",""],["","065862039010","ONDANSETRON ","4MG ODT","12","Select","Select",""],["","070710113908","FLUCONAZOLE ","150MG","2","Select","Select",""],["","053746010901","HYDROCO\/APAP ","5-325MG","12","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","",""],["No","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","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":""}]}]}