{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JOHN T JOHNSON","gend":0,"add":"11357 JACKSON TRAIL  ","city":"SPOTSYLVANIA","state":"VA","zip":"22553-3758","dob":"1970-07-18","age":"","mstatus":"","insh":11017337,"cliId":"6R23QJ2MK00","pno":7032327757,"cno":"","email":"","ename":"","eno":"","pphy":"SELWYN A ADAMS MD ","ppno":5403741188,"pcpadd":"2301 Fall Hill Ave Ste 301","pcpcity":"Fredericksburg ","pcpstate":"VA","pcpzip":224013349,"pcpcounty":"","pcpid":"P0124235","pcpname":"SELWYN A ADAMS MD","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"","add3":"","madd1":"11357 JACKSON TRAIL  ","madd2":"","madd3":"","mcity":"SPOTSYLVANIA","mstate":"VA","mzip":"22553-3758","pcpfaxno":"                    ","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["B20","E78.1","E78.2","G62.9","J01.00","I80.8","H10.9","Z72.51"],"date":["2021-07-30","2021-05-03","2021-03-23","2021-03-23","2021-07-08","2021-07-30","2021-10-22","2021-10-22"],"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":[["","61958210101","ODEFSEY","TAB ","","Select","Select",""],["","14539067501","HYDROXYZ PAM","CAP 50MG","","Select","Select",""],["","64380076111","OMEGA-3-ACID","CAP 1GM","","Select","Select",""],["","93770198","LEVOCETIRIZI","TAB 5MG","","Select","Select",""],["","115152310","FENOFIBRATE","TAB 120MG","","Select","Select",""],["","143980305","DOXYCYCL HYC","CAP 100MG","","Select","Select",""],["","591544305","PREDNISONE","TAB 20MG","","Select","Select",""],["","70377002811","ATORVASTATIN","TAB 20MG","","Select","Select",""],["","70347010530","FIBRICOR","TAB 105MG","","Select","Select",""],["","61958210101","ODEFSEY ","TAB ","30","Select","Select",""],["","93770198","LEVOCETIRIZI ","TAB 5MG","30","Select","Select",""],["","64380076111","OMEGA-3-ACID ","CAP 1GM","120","Select","Select",""],["","115152310","FENOFIBRATE ","TAB 120MG","30","Select","Select",""],["","14539067501","HYDROXYZ ","CAP 50MG","60","Select","Select",""],["","69238167801","FLUPHENAZINE ","TAB 1MG","60","Select","Select",""],["","70377002911","ATORVASTATIN ","TAB 40MG","90","Select","Select",""],["","68180071160","CEFDINIR ","300MG","14","Select","Select",""],["","378064205","PREDNISONE ","20MG","10","Select","Select",""],["","143980305","DOXYCYCL ","100MG","20","Select","Select",""],["","70347010530","FIBRICOR ","105MG","30","Select","Select",""],["","65862050320","AMOX\/K ","875-125","14","Select","Select",""],["","14539067501","HYDROXYZ","50MG","60","Select","Select",""],["","69238167801","FLUPHENAZINE","1MG","60","Select","Select",""],["","65862050320","AMOX\/K","875-125","14","Select","Select",""],["","68180071160","CEFDINIR","300MG","14","Select","Select",""],["","53489011905","DOXYCYCL","100MG","14","Select","Select",""],["","59148003713","REXULTI","1MG","30","Select","Select",""],["","59148003713","REXULTI ","TAB 1MG","30","Select","Select",""],["","66993068130","OLANZAPINE ","TAB 5MG","30","Select","Select",""],["","24208067004","SOD ","SOL 10% OP","15","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","",false,""],["No","Select","",false,""],["No","Select","",false,""],["Yes","Select","",false,""],["No","Select","",false,""],["No","Select","",false,""],["N\/A","Select","",false,""]]]},{"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":""}]}]}