{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"C   YRAGSNOSRAP ","gend":0,"add":"AL 64231TC SENW","city":"SMITHFIELD","state":"VA","zip":"23430-9998","dob":"1949-08-08","age":"","mstatus":"","insh":"83000910*736","cliId":"3WD1HJ6UE04","pno":"53\/7575614-7","cno":"757\/357-4165","email":"","ename":"","eno":"","pphy":"KNUST, LISA M MD","ppno":"757\/238-7043","pcpadd":"13478 CARROLLTON BOULEVARD STE D &","pcpcity":"CARROLLTON","pcpstate":"VA","pcpzip":23314,"pcpcounty":"","pcpid":118380,"pcpname":"Eagle Harbor Primary Care","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":["R00.1","I48.0","I11.9","E78.5","E03.9","M17.12","Z68.34","Z96.652","G47.33","D48.5","C61.","D12.6","Z00.00","I10.","Z87.891","R05.","D49.2","D37.4","I48.19","Z01.812","Z20.828","G47.00","R35.1","J30.9","K68.19","R10.9","Z12.11","Z01.30","R73.9","M79.671","M79.672","G89.29","Z79.01","Z86.010","L90.5","I49.1","M25.562","E11.69"],"date":["2020-07-31","2021-11-19","2021-11-19","2021-11-19","2021-10-26","2020-11-20","2020-11-20","2020-11-20","2021-09-01","2021-02-04","2021-04-13","2020-09-25","2020-10-21","2021-04-20","2021-04-20","2020-10-21","2021-01-05","2020-08-06","2020-08-06","2020-09-21","2020-09-21","2021-09-01","2021-09-01","2021-09-01","2020-07-13","2020-07-13","2020-10-01","2020-12-04","2021-07-16","2021-04-20","2021-04-20","2021-04-20","2020-10-01","2020-07-20","2021-03-01","2020-07-31","2020-11-20","2021-11-19"],"priorHcc":["",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":[["","69238183001","LEVOTHYROXIN ","25MCG","90","Select","Select",""],["","65862073260","AMIODARONE ","200MG","-90","Select","Select",""],["","00003089421","ELIQUIS ","5MG","60","Select","Select",""],["","68382052842","CHOLESTYRAM ","4GM","2268","Select","Select",""],["","68382059505","DILTIAZEM ","120MG ER","90","Select","Select",""],["","00955101510","ENOXAPARIN ","150MG\/ML","-2","Select","Select",""],["","00406051201","OXYCOD\/APAP ","5-325MG","30","Select","Select",""],["","43386009019","GAVILYTE-G ","","4000","Select","Select",""],["","58160082311","SHINGRIX ","50\/0.5ML","1","Select","Select",""],["","52268010101","GOLYTELY ","PINEAPPL","4000","Select","Select",""],["","68382013610","LOSARTAN ","50MG","30","Select","Select",""],["","67877049090","EZETIMIBE ","10MG","90","Select","Select",""],["","49281012065","FLUZONE ","PF 20-21","1","Select","Select",""],["","31722052010","HYDRALAZINE ","25MG","180","Select","Select",""],["","45802010901","TRIAMCINOLON ","55MCG\/AC","17","Select","Select",""],["","51672131003","AUG ","0.05%","-45","Select","Select",""],["","067877069601","CHLORTHALID ","25MG","90","Select","Select",""],["","58160084252","BOOSTRIX ","","0","Select","Select",""],["","65862073260","","200MG","-90","Select","Select",""],["","65862073260","AMIODARONE","200MG","90","Select","Select",""],["","69238183001","LEVOTHYROXIN","25MCG","90","Select","Select",""],["","00003089421","ELIQUIS","5MG","60","Select","Select",""],["","68382059505","DILTIAZEM","120MG ER","90","Select","Select",""],["","68382052860","CHOLESTYRAM","4GM","90","Select","Select",""],["","58160082311","SHINGRIX","50\/0.5ML","1","Select","Select",""],["","43386009019","GAVILYTE-G","","4000","Select","Select",""],["","52268010101","GOLYTELY","PINEAPPL","4000","Select","Select",""],["","68382013610","LOSARTAN","50MG","30","Select","Select",""],["","45802010901","TRIAMCINOLON","55MCG\/AC","17","Select","Select",""],["","00406051201","OXYCOD\/APAP","5-325MG","30","Select","Select",""],["","00955101510","ENOXAPARIN","150MG\/ML","-2","Select","Select",""],["","49281012065","FLUZONE","PF 20-21","1","Select","Select",""],["","31722052010","HYDRALAZINE","25MG","180","Select","Select",""],["","51672131003","AUG","0.05%","45","Select","Select",""],["","67877049090","EZETIMIBE","10MG","-90","Select","Select",""],["","67877069601","CHLORTHALID","25MG","90","Select","Select",""],["","58160084252","BOOSTRIX","","0","Select","Select",""],["","80777027398","MODERNA ","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":[[["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":""}]}]}