{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DELILAH   M DUPREE","gend":1,"add":"1108 BETHEL ROAD","city":"CHESAPEAKE","state":"VA","zip":"23324-9998","dob":"1953-04-04","age":"","mstatus":"","insh":"900032159*01","cliId":"7RR6UD7NA72","pno":"757\/321-6137","cno":"757\/321-6137","email":"","ename":"","eno":"","pphy":"ISMAELI-CAMPBELL, ATTIYAH MD","ppno":"757\/983-1777","pcpadd":"213 RIVER WALK PKWY STE 101","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":23320,"pcpcounty":"","pcpid":700507,"pcpname":"","plan":"OHP","program":"MEDICARE","lob":"MA-NON DSNP","region":"TIDEWATER","aligned":"","ano":"757\/321-6137","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":["R73.01","I10.","E78.5","Z12.31","M25.561","M25.562","H25.13","H52.03","H52.223","H52.4","M17.0","M17.11","M17.12","Z13.828","Z76.0","N95.0","Z00.00","Z12.39","Z86.69","Z23.","R26.81","R42.","R09.81"],"date":["2021-07-14","2021-07-14","2021-07-14","2021-06-26","2021-07-14","2021-07-14","2020-09-02","2020-09-02","2020-09-02","2020-09-02","2021-07-14","2020-11-03","2020-11-03","2020-11-03","2020-11-17","2020-03-02","2021-07-14","2020-06-04","2021-07-14","2020-11-17","2021-07-14","2021-07-14","2021-07-14"],"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":[["","65162010150","GABAPENTIN ","100MG","90","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","29300012410","MELOXICAM ","7.5MG","60","Select","Select",""],["","66993001968","ALBUTEROL ","HFA","18","Select","Select",""],["","00378001805","METOPROL ","25MG","-90","Select","Select",""],["","29300012810","HYDROCHLOROT ","25MG","90","Select","Select",""],["","55111012105","ATORVASTATIN ","10MG","90","Select","Select",""],["","00173068220","VENTOLIN ","","18","Select","Select",""],["","65862001705","AMOXICILLIN ","500MG","40","Select","Select",""],["","00116200116","CHLORHEX ","0.12%","473","Select","Select",""],["","59267100002","PFIZER ","COVID-19","0","Select","Select",""],["","060505082901","FLUTICASONE ","50MCG","16","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":""}]}]}