{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DUANE SHERMAN","gend":0,"add":"1006 HILLPOINT RD ","city":"SUFFOLK  ","state":"VA","zip":"23434-9998","dob":"1981-12-29","age":"","mstatus":"","insh":11018140,"cliId":"9J82DJ3NJ14","pno":7574519445,"cno":7572014399,"email":"","ename":"","eno":"","pphy":"VAUGHN, LINDSAY D ","ppno":7579838750,"pcpadd":"2050 Hillpoint Blvd N # Ref","pcpcity":"Suffolk  ","pcpstate":"VA","pcpzip":234347181,"pcpcounty":"","pcpid":"P0152212","pcpname":"SENTARA FAMILY MEDICINE PHYSICIANS","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"TIDEWATER","aligned":"Y","ano":"","add2":"","add3":"","madd1":"1006 HILLPOINT RD ","madd2":"","madd3":"","mcity":"SUFFOLK  ","mstate":"VA","mzip":"23434-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F20.9","B35.1","E55.9","I10","F17.200","Z13.220","R53.83","E78.5","G47.00","Z01.89"],"date":["2021-09-17","2021-07-23","2021-10-01","2021-10-01","2021-07-23","2021-09-17","2021-09-17","2021-10-01","2021-09-17","2021-10-01"],"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":[["","50458060801","INVEGA ","546MG","1.75","Select","Select",""],["","57237001206","MIRTAZAPINE ","30MG ODT","90","Select","Select",""],["","16729018201","HYDROCHLOROT ","12.5MG","30","Select","Select",""],["","57237001206","MIRTAZAPINE","30MG ODT","90","Select","Select",""],["","50458060801","INVEGA","546MG","1.75","Select","Select",""],["","16729018201","HYDROCHLOROT","12.5MG","60","Select","Select",""],["","68180072103","AMLODIPINE","10MG","60","Select","Select",""],["","68180072103","AMLODIPINE ","TAB 10MG","60","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","",""],["No","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":""}]}]}