{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"  ADERFLANOTSNIW C","gend":1,"add":"IRG 0282EVA NIFF","city":"RICHMOND","state":"VA","zip":23222,"dob":"1952-01-20","age":"","mstatus":"","insh":"53000910*068","cliId":"","pno":"23\/4088439-1","cno":"","email":"","ename":"","eno":"","pphy":"Lloyd, Bonner","ppno":"804\/325-8801","pcpadd":"2401 W Leigh St STE 200","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":23222,"pcpcounty":"","pcpid":"","pcpname":"BON SECOURS SPORTS MEDICINE & PRIMARY CARE","plan":"OHP","program":"Medicare","lob":"DSNP","region":"CENTRAL","aligned":"Y","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":["Z00.00","I10.","Z13.31","K58.0","M47.26","R19.4","E80.6","E78.5","R15.1","K52.9","K57.30","K64.8","K21.9","M19.90","E78.00","Z87.891","Z85.41","R19.7","L50.9","R59.1","Z08.","R15.9","Z11.51","R10.84","Z01.812","Z20.822","R73.02","C53.9","Z12.11","R20.8","Z68.25","K52.89","K57.90","Z68.26","Z12.31","Z92.21","Z92.3","Z12.4","J45.20","Z68.27","R23.8"],"date":["2020-11-24","2021-10-18","2020-11-24","2021-10-18","2021-10-18","2020-11-24","2020-12-15","2021-10-18","2021-02-02","2021-04-19","2021-04-19","2021-04-19","2021-04-19","2021-04-19","2021-04-19","2021-04-19","2021-04-19","2021-04-19","2021-07-26","2020-04-13","2021-02-15","2021-02-15","2021-02-15","2021-04-19","2021-04-15","2021-04-15","2021-07-26","2021-02-15","2021-05-23","2021-10-18","2020-05-05","2021-04-19","2021-04-19","2021-03-23","2021-06-30","2020-02-12","2020-02-12","2020-02-12","2020-06-23","2021-07-26","2021-07-26"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}}]},{"t":"Covid Screening","q":[{"a":[]}]},{"t":"Self-Assessment and Social History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":{"indx":["",""],"comment":["",""],"sub":[]}},{"a":{"indx":["",""],"comment":["",""],"sub":[]}},{"a":{"indx":["",""],"comment":["",""],"sub":[]}},{"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":[["","55111014512","FLUCONAZOLE","TAB 150MG","1","Select","Select",""],["","68645051554","AMLODIPINE BESYLATE","TAB 5MG","90","Select","Select",""],["","59746017310","PREDNISONE","TAB 10MG","-20","Select","Select",""],["","00527058601","DICYCLOMINE HYDROCHLORIDE","CAP 10MG","120","Select","Select",""],["","00093505898","ATORVASTATIN CALCIUM","TAB 40MG","90","Select","Select",""],["","31722071390","PANTOPRAZOLE SODIUM","TAB 40MG","30","Select","Select",""],["","69238115403","EZETIMIBE","TAB 10MG","-30","Select","Select",""],["","27241013436","CHOLESTYRAMINE","POW 4GM","60","Select","Select",""],["","52268001201","SUPREP BOWEL PREP KIT","SOL PREP KIT","354","Select","Select",""],["","55111064530","OMEPRAZOLE","CAP 40MG","30","Select","Select",""],["","61314064705","TOBRAMYCIN\/DEXAMETHASONE","SUS 0.3-0.1%","5","Select","Select",""],["","67877022310","GABAPENTIN","CAP 300MG","30","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":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"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":""}]}]}