{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DONNA   M GARDNER","gend":1,"add":"28 E CRISER RD","city":"FRONT ROYAL","state":"VA","zip":"22630-9998","dob":"1950-01-31","age":"","mstatus":"","insh":"900036473*01","cliId":"3G86MP8CC50","pno":"540\/692-5682","cno":"540\/692-5682","email":"","ename":"","eno":"","pphy":"","ppno":"","pcpadd":"","pcpcity":"","pcpstate":"","pcpzip":"","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"NORTHERN & WINCHESTER","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":["K65.4","R10.84","R19.7","I11.0","E78.5","E11.9","I10.","E78.2","J45.20","E55.9","G47.00","R12.","Z86.39","Z13.29","Z13.0","M79.3","K57.30","K44.9","J81.1","S52.501A","S52.611A","R29.6","S62.101A","W01.0XXA","S52.571A","Z86.73","Z98.84","G47.33","M25.531","Z01.818","J44.9","K21.9","M19.90","Z79.51","Z79.82","Z79.899","Z80.3","Z86.010","Z88.0","Z13.1","R80.9","G56.01","G89.18","Z98.890","Z87.81","Z68.39","E66.01","K63.5","E53.8","D50.9","Z12.31","M81.0","E27.8","Z12.11"],"date":["2020-10-25","2020-10-25","2020-10-25","2020-10-25","2021-10-21","2021-10-21","2021-11-08","2021-06-21","2021-06-14","2021-10-21","2020-12-14","2021-06-14","2021-06-21","2020-12-14","2020-12-14","2020-10-25","2020-10-25","2020-10-25","2020-10-25","2021-02-24","2021-02-24","2021-02-24","2021-02-24","2021-02-24","2021-04-01","2021-05-14","2021-06-21","2021-06-14","2021-03-05","2021-05-11","2021-05-14","2021-06-15","2021-03-05","2021-05-14","2021-05-14","2021-05-14","2021-05-14","2021-06-21","2021-05-14","2020-09-09","2020-09-09","2021-07-02","2021-03-05","2021-07-02","2021-07-02","2021-05-14","2021-05-14","2021-06-14","2021-10-21","2021-06-15","2021-08-10","2021-08-10","2021-06-21","2021-05-23"],"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":[["","93005805","TRAMADOL HCL","TAB 50MG","15","Select","Select",""],["","29300022705","METRONIDAZOL","TAB 500MG","30","Select","Select",""],["","69452015120","VITAMIN D","CAP 50000UNT","4","Select","Select",""],["","72205000599","ROSUVASTATIN","TAB 40MG","90","Select","Select",""],["","57896090110","ASPIRIN","TAB 325MG","90","Select","Select",""],["","173071520","ADVAIR HFA","AER 45\/21","12","Select","Select",""],["","68382041205","OMEPRAZOLE","CAP 20MG","90","Select","Select",""],["","68382080505","TRAZODONE","TAB 50MG","30","Select","Select",""],["","53746010901","HYDROCO\/APAP","TAB 5-325MG","30","Select","Select",""],["","16714065202","CIPROFLOXACN","TAB 500MG","10","Select","Select",""],["","65862054890","VALSART\/HCTZ","TAB 160-12.5","90","Select","Select",""],["","57896090110","ASPIRIN ","","90","Select","Select",""],["","72205000599","ROSUVASTATIN CALCIUM ","","90","Select","Select",""],["","65862054890","VALSARTAN\/HYDROCHLOROTHIAZIDE","","90","Select","Select",""],["","68382080505","TRAZODONE HYDROCHLORIDE","","30","Select","Select",""],["","69452015120","VITAMIN D ","","4","Select","Select",""],["","29300022705","METRONIDAZOLE ","","30","Select","Select",""],["","16714065202","CIPROFLOXACIN HYDROCHLORIDE ","","10","Select","Select",""],["","53746010901","HYDROCODONE\/ACETAMINOPHEN ","","10","Select","Select",""],["","72205000599","ROSUVASTATIN CALCIUM","","90","Select","Select",""],["","16714065202","CIPROFLOXACIN HYDROCHLORIDE","","10","Select","Select",""],["","29300022705","METRONIDAZOLE","","30","Select","Select",""],["","53746010901","HYDROCODONE\/ACETAMINOPHEN","","10","Select","Select",""],["","59779050301","CVS OMEPRAZOLE","","90","Select","Select",""],["","75834002001","VITAMIN D3","","12","Select","Select",""],["","10939086944","SM VITAMIN D3 MAXIMUM STRENGTH","","12","Select","Select",""],["","65862054890","VALSARTAN\/HYDROCHLOROTHIAZIDE                                         ","TAB 160-12.5","90","Select","Select",""],["","00173071520","ADVAIR HFA                                                            ","AER 45\/21","12","Select","Select",""],["","72205000599","ROSUVASTATIN CALCIUM                                                  ","TAB 40MG","90","Select","Select",""],["","57896090110","ASPIRIN                                                               ","TAB 325MG","90","Select","Select",""],["","68382041205","OMEPRAZOLE                                                            ","CAP 20MG","90","Select","Select",""],["","68382080505","TRAZODONE HYDROCHLORIDE                                               ","TAB 50MG","30","Select","Select",""],["","69452015120","VITAMIN D                                                             ","CAP 50000UNT","4","Select","Select",""],["","53746010901","HYDROCODONE\/ACETAMINOPHEN                                             ","TAB 5-325MG","30","Select","Select",""],["","16714065202","CIPROFLOXACIN HYDROCHLORIDE                                           ","TAB 500MG","10","Select","Select",""],["","29300022705","METRONIDAZOLE                                                         ","TAB 500MG","30","Select","Select",""],["","00093005805","TRAMADOL HCL                                                          ","TAB 50MG","15","Select","Select",""],["","59779050301","CVS OMEPRAZOLE                                                        ","TAB 20MG","90","Select","Select",""],["","75834002001","VITAMIN D3                                                            ","CAP 50000UNT","12","Select","Select",""],["","10939086944","SM VITAMIN D3 MAXIMUM STRENGTH                                        ","CAP 5000UNIT","12","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","",""],["Yes","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":""}]}]}