{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BONNIE   S THORNTON","gend":1,"add":"3632 RIVERSIDE DR","city":"NORFOLK","state":"VA","zip":"23502-9998","dob":"1954-11-21","age":"","mstatus":"","insh":"900033756*01","cliId":"4UM3V83RC09","pno":"757\/675-1309","cno":"757\/675-1309","email":"","ename":"","eno":"","pphy":"","ppno":"","pcpadd":"","pcpcity":"","pcpstate":"","pcpzip":"","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICARE","lob":"MA-NON DSNP","region":"TIDEWATER","aligned":"","ano":"","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":["R11.0","R15.9","K76.0","K31.9","R41.0","R11.2","R53.1","R51.9","R29.818","I67.850","R50.9","R10.9","R27.0","Z90.49","R07.9","E78.5","I67.3","G43.809","G46.7","R26.9","G31.84","R20.0","G43.109","K29.70","I36.1","Z00.00","M85.80","Z23.","Z78.0","Z87.828","R42."],"date":["2020-06-05","2020-04-07","2020-04-07","2020-04-07","2021-05-14","2021-05-14","2021-05-14","2021-05-15","2021-05-14","2021-06-16","2021-05-15","2020-06-05","2021-05-14","2020-06-05","2021-05-14","2020-03-10","2021-06-10","2021-06-10","2021-06-10","2021-06-10","2021-06-10","2021-05-13","2021-06-16","2020-03-10","2021-05-14","2021-06-16","2021-07-15","2021-06-16","2021-07-15","2021-07-15","2021-07-23"],"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":[["","50228017705","GABAPENTIN ","600MG","180","Select","Select",""],["","55111015930","OMEPRAZOLE ","40MG","30","Select","Select",""],["","65162006205","SUCRALFATE ","1GM\/10ML","-420","Select","Select",""],["","58914017014","CARAFATE ","1GM\/10ML","-420","Select","Select",""],["","68645049554","ATORVASTATIN ","80MG","90","Select","Select",""],["","80777027399","MODERNA ","COVID-19","0","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":""}]}]}