{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"EMMETT L BAILEY JR","gend":0,"add":"219 PROSPECT ROAD RM 302","city":"SUFFOLK","state":"VA","zip":23434,"dob":"1951-11-26","age":"","mstatus":"","insh":"900035781*01","cliId":"","pno":"757\/923-3894","cno":"757\/923-3894  757\/292-3757  ","email":"","ename":"","eno":"","pphy":"","ppno":"","pcpadd":"","pcpcity":"","pcpstate":"","pcpzip":"","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP - OPTIMA","program":"MEDICARE","lob":"DSNP","region":"Southside","aligned":"Y","ano":"757\/923-3894, 757\/292-3757, ","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":["U07.1","I10.","J45.909","R26.89","K57.30","M62.81","R25.2","S14.109S","F41.9","M19.90","M81.0","N40.0","K59.09","E27.8","E78.00","F10.10","Z99.3","G60.9","I73.9","R60.9","L84.","B35.1","M20.41","M20.42","K57.32","R05.","R07.9","R50.9","K59.00","Z20.828","R10.9","K57.92","R53.81","R56.9","Z86.010","K64.0","Z09.","Z23.","Z86.19","Z00.00","I70.0","Z91.81","R73.9","M25.632","E61.1","R53.83","Z86.16","N40.1","N52.9","N13.8","E87.6","Z12.11","G82.22","S14.109A","M21.371","M21.372","Z87.828","K56.7","R53.1","Z82.49","Z82.5","Z83.3","Z80.9","Z79.899","R06.02","R26.9","G81.94","Z01.812","Z74.3","Z85.46","E11.9","Z12.5"],"date":["2021-01-01","2021-03-11","2020-11-30","2021-03-11","2021-02-26","2020-12-03","2020-10-01","2020-10-01","2020-10-01","2020-11-30","2020-11-30","2020-10-01","2020-10-01","2020-10-01","2020-11-30","2020-10-01","2020-10-01","2021-03-03","2021-03-03","2021-03-03","2021-03-03","2021-03-03","2021-03-03","2021-03-03","2020-08-15","2020-08-15","2020-08-06","2020-08-15","2021-01-25","2021-02-22","2020-11-30","2020-08-15","2021-03-11","2020-08-11","2021-02-26","2021-02-26","2020-09-18","2020-09-18","2020-09-18","2021-03-11","2021-03-11","2021-03-11","2021-03-11","2021-03-11","2021-03-11","2021-03-11","2021-03-11","2021-03-19","2019-08-26","2021-03-19","2020-08-20","2020-11-30","2021-01-01","2021-01-01","2020-11-24","2020-11-24","2020-11-24","2020-08-15","2020-08-03","2020-08-03","2020-08-03","2020-08-03","2020-08-03","2020-08-03","2020-11-16","2020-11-16","2020-11-24","2021-02-22","2020-08-15","2020-11-30","2020-11-30","2021-03-19"],"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":[["","65862059801","TAMSULOSIN","CAP 0.4MG","30","Select","Select",""],["","5417990","CENTRUM SILV","TAB ADULT 50","14","Select","Select",""],["","43292055540","VITAMIN B","TAB COMPLEX","30","Select","Select",""],["","64764008060","AMITIZA","CAP 8MCG","60","Select","Select",""],["","254302902","LUBIPROSTONE","CAP 24MCG","60","Select","Select",""],["","5197102","PREVNAR 13","INJ ","0","Select","Select",""],["","70461001903","FLUAD","INJ 2019-20","0","Select","Select",""],["","57896045501","SENNA PLUS","TAB 8.6-50MG","28","Select","Select",""],["","65862050320","AMOX\/K CLAV","TAB 875-125","8","Select","Select",""],["","10006070022","VITAMIN B-12","TAB 1000MCG","14","Select","Select",""],["","904673080","ACETAMIN","TAB 500MG","30","Select","Select",""],["","536123801","BISACODYL","SUP 10MG","2","Select","Select",""],["","35046000334","OMEGA III","CAP EPA+DHA","14","Select","Select",""],["","45802086802","POLYETH GLYC","POW 3350 NF","238","Select","Select",""],["","50383077930","LACTULOSE","SOL 10GM\/15","420","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":[[["Select","Select","","","","","Select","",""],["Select","Select","","","","","Select","",""],["Select","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Select","Select","","","","","Select","",""],["No","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":""}]}]}