{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DEBORAH   J LOWE","gend":1,"add":"531 LONGBRANCH DR","city":"LA CROSSE","state":"VA","zip":"23950-9998","dob":"1948-06-09","age":"","mstatus":"","insh":"900036304*01","cliId":"4VM6GE3DP49","pno":"434\/878-0214","cno":"434\/878-0214","email":"","ename":"","eno":"","pphy":"POWERS, DAVID C MD","ppno":"434\/584-2025","pcpadd":"514 W ATLANTIC ST","pcpcity":"SOUTH HILL","pcpstate":"VA","pcpzip":23970,"pcpcounty":"","pcpid":210251,"pcpname":"","plan":"OHP","program":"MEDICARE","lob":"MA-Non DSNP","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/447-2240","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["H25.11","E78.5","I10.","E03.9","R73.9","Z12.31","H25.12","H04.123","H18.231","Z12.11","H26.493","H43.393","H18.232","R92.8","H25.13","Z96.1"],"date":["2020-02-26","2021-02-22","2021-08-30","2021-02-22","2021-02-22","2021-04-08","2020-02-03","2021-08-24","2020-06-08","2021-07-16","2021-08-24","2021-08-24","2020-02-11","2021-04-16","2020-01-20","2021-08-24"],"priorHcc":["","",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":[["","17478071310","OFLOXACIN ","0.3% OP","5","Select","Select",""],["","61314063705","PREDNISOLONE ","1% OP","-15","Select","Select",""],["","45963070996","METOPROL ","25MG ER","90","Select","Select",""],["","68645057054","CITALOPRAM ","20MG","90","Select","Select",""],["","00781518292","LEVOTHYROXIN ","75MCG","90","Select","Select",""],["","49281012065","FLUZONE ","PF 20-21","1","Select","Select",""],["","72305007530","EUTHYROX ","75MCG","90","Select","Select",""],["","17478071310","","0.3% OP","5","Select","Select",""],["","61314063705","PREDNISOLONE","1% OP","-15","Select","Select",""],["","00781518292","LEVOTHYROXIN","75MCG","90","Select","Select",""],["","45963070996","METOPROL","25MG ER","90","Select","Select",""],["","17478071310","OFLOXACIN","0.3% OP","5","Select","Select",""],["","68645057054","CITALOPRAM","20MG","90","Select","Select",""],["","49281012065","FLUZONE","PF 20-21","1","Select","Select",""],["","72305007530","EUTHYROX","75MCG","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":""}]}]}