{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SHARMAIN HELLAMNS","gend":1,"add":"212 TALLEY PLACE  ","city":"NEWPORT NEWS","state":"VA","zip":"23608-9998","dob":"1961-07-15","age":"","mstatus":"","insh":11009167,"cliId":"2MH5VV1MC76","pno":7572369272,"cno":7572369272,"email":"","ename":"","eno":"","pphy":"HERBERT, DWIGHT","ppno":"               ","pcpadd":"10852 Warwick Blvd","pcpcity":"Newport News","pcpstate":"VA","pcpzip":236013741,"pcpcounty":"","pcpid":"P9058712","pcpname":"HILTON FAMILY PRACTICE","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"TIDEWATER","aligned":"Y","ano":"","add2":"","add3":"","madd1":"212 TALLEY PLACE  ","madd2":"","madd3":"","mcity":"NEWPORT NEWS","mstate":"VA","mzip":"23608-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["K59.00","R14.0","R94.31","D69.6","D64.9","Z87.891","I10","F20.9","Z79.899","R10.9","F25.9","F20.5"],"date":["2020-01-19","2020-01-19","2020-01-19","2020-01-19","2020-01-19","2020-01-19","2020-01-19","2020-01-19","2020-01-19","2020-01-19","2021-01-13","2019-11-07"],"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":{"indx":["","",""],"comment":["","",""],"sub":[]}},{"a":{"indx":["","",""],"comment":["","",""],"sub":[]}}]},{"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":[["","65862059501","DIVALPROEX","TAB 500MG ER","","Select","Select",""],["","69315013601","BENZTROPINE","TAB 0.5MG","","Select","Select",""],["","13668033101","TRAZODONE","TAB 100MG","","Select","Select",""],["","55111016830","OLANZAPINE","TAB 20MG","","Select","Select",""],["","55111016830","OLANZAPINE ","TAB 20MG","90","Select","Select",""],["","69315013601","BENZTROPINE ","TAB 0.5MG","180","Select","Select",""],["","16714048501","DIVALPROEX ","TAB 500MG ER","90","Select","Select",""],["","60505265401","TRAZODONE ","TAB 100MG","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":[[["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":""}]}]}