{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DANIEL   L JORDAN","gend":0,"add":"50 CAVALIER DR APT 102","city":"NORTH DINWIDDIE","state":"VA","zip":"23805-9998","dob":"1980-07-29","age":"","mstatus":"","insh":"900035992*01","cliId":"6HC0G11QT34","pno":"434\/709-1652","cno":"434\/709-1652","email":"","ename":"","eno":"","pphy":"YOSAY, JOHN MD","ppno":"","pcpadd":"436 CLAIRMONT COURT SUITE 100","pcpcity":"COLONIAL HEIGHTS","pcpstate":"VA","pcpzip":23834,"pcpcounty":"","pcpid":208807,"pcpname":"SOUTHSIDE PHYSICIANS NETWORK - FAMILY MEDICINE","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"Non-DSNP","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":["E11.65","E55.9","N18.3","I10.","E11.9","E78.5","F33.1","F20.9","F81.9","G45.0","R09.89","E78.2","Z68.30","H50.112","H27.01","E11.319","H47.293","H35.3132","Z68.29","H31.093","N18.2","E66.9","H25.12","H35.411","H04.123"],"date":["2021-01-14","2021-08-23","2020-09-17","2021-08-23","2021-09-27","2021-08-10","2021-10-04","2021-01-14","2020-06-18","2021-01-07","2021-01-07","2021-01-14","2020-09-17","2021-09-27","2020-07-07","2020-07-07","2020-07-07","2020-01-23","2021-01-14","2020-02-10","2021-08-23","2021-08-23","2021-09-27","2021-09-27","2021-09-27"],"priorHcc":["","","","",null,null,null,"","","","","","",null,"","","","","","","","",null,null,null]}},{"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":[["","43547033710","BENAZEPRIL","TAB 20MG","-1","Select","Select",""],["","378623201","CITALOPRAM","TAB 20MG","30","Select","Select",""],["","23155050105","HYDROXYZ HCL","TAB 25MG","60","Select","Select",""],["","13668022030","ARIPIPRAZOLE","TAB 20MG","18","Select","Select",""],["","67877056105","METFORMIN","TAB 500MG","-270","Select","Select",""],["","68180072003","AMLODIPINE","TAB 5MG","90","Select","Select",""],["","65162024709","CHLORTHALID","TAB 25MG","90","Select","Select",""],["","59762015601","ATORVASTATIN","TAB 20MG","-90","Select","Select",""],["","378623201","CITALOPRAM HYDROBROMIDE","","30","Select","Select",""],["","59762015601","ATORVASTATIN CALCIUM ","","90","Select","Select",""],["","68180072003","AMLODIPINE BESYLATE","","-90","Select","Select",""],["","43547033710","BENAZEPRIL HYDROCHLORIDE","","-90","Select","Select",""],["","378022210","CHLORTHALIDONE","","90","Select","Select",""],["","93506105","HYDROXYZINE HYDROCHLORIDE ","","60","Select","Select",""],["","23155010205","METFORMIN HYDROCHLORIDE","","180","Select","Select",""],["","55111012205","ATORVASTATIN CALCIUM","","90","Select","Select",""],["","10702001150","HYDROXYZINE HYDROCHLORIDE","","-16","Select","Select",""],["","68180072003","AMLODIPINE BESYLATE                                                   ","TAB 5MG","90","Select","Select",""],["","55111012205","ATORVASTATIN CALCIUM                                                  ","TAB 20MG","90","Select","Select",""],["","00378623201","CITALOPRAM HYDROBROMIDE                                               ","TAB 20MG","30","Select","Select",""],["","23155010205","METFORMIN HYDROCHLORIDE                                               ","TAB 500MG","180","Select","Select",""],["","65862066530","ARIPIPRAZOLE                                                          ","TAB 20MG","30","Select","Select",""],["","00093506105","HYDROXYZINE HYDROCHLORIDE                                             ","TAB 25MG","16","Select","Select",""],["","65162024709","CHLORTHALIDONE                                                        ","TAB 25MG","90","Select","Select",""],["","43547033710","BENAZEPRIL HYDROCHLORIDE                                              ","TAB 20MG","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":[[["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["Yes","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":""}]}]}