{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MARVIN   D PRICE JR","gend":0,"add":"PO BOX 16531","city":"CHESAPEAKE","state":"VA","zip":"23328-9998","dob":"1950-04-02","age":"","mstatus":"","insh":"900033287*01","cliId":"2Y58D19MJ31","pno":"757\/576-1076","cno":"757\/576-1076","email":"","ename":"","eno":"","pphy":"FREEMAN, E THOMAS MD","ppno":"757\/420-8297","pcpadd":"1016 JUSTIS ST","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":23325,"pcpcounty":"","pcpid":163774,"pcpname":"INDIAN RIVER FAMILY PRACTICE","plan":"OHP","program":"MEDICARE","lob":"MA-Non DSNP","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/523-5639","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R03.0","Z83.71","C61.","K59.00","I10.","T78.3XXA","T46.4X5A","Z12.11","Z00.00"],"date":["2020-06-30","2020-06-30","2020-06-30","2020-06-30","2021-05-12","2020-08-27","2020-08-27","2020-09-30","2020-08-13"],"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":[["","068180098003","LISINOPRIL ","10MG","90","Select","Select",""],["","050111043303","TRAZODONE ","50MG","90","Select","Select",""],["","068180072003","AMLODIPINE ","5MG","90","Select","Select",""],["","000093317431","ALBUTEROL ","HFA","-34","Select","Select",""],["","066993058497","FLUTIC\/SALME ","100\/50","180","Select","Select",""],["","68180072003","","5MG","90","Select","Select",""],["","68180072003","AMLODIPINE","5MG","90","Select","Select",""],["","00093317431","ALBUTEROL","HFA","-34","Select","Select",""],["","66993058497","FLUTIC\/SALME","100\/50","-180","Select","Select",""],["","68180098003","LISINOPRIL","10MG","90","Select","Select",""],["","50111043303","TRAZODONE","50MG","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":""}]}]}