{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"VERA   M JONES","gend":1,"add":"3413 HARDEE CT","city":"HAMPTON","state":"VA","zip":"23666-9998","dob":"1954-04-05","age":"","mstatus":"","insh":"900036759*01","cliId":"7HW0J22EA16","pno":"757\/826-5258","cno":"757\/826-5258","email":"","ename":"","eno":"","pphy":"ATIQ, AIDA MD","ppno":"757\/827-1940","pcpadd":"2148 WEST MERCURY BOULEVARD","pcpcity":"HAMPTON","pcpstate":"VA","pcpzip":23666,"pcpcounty":"","pcpid":118380,"pcpname":"Riverside Medical Care Center - Mercury West","plan":"OHP","program":"MEDICARE","lob":"MA-NON DSNP","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/896-4715","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I10.","E78.49","R73.9","J84.9","Z12.31","M25.512","R73.03","Z01.419","Z11.51","M75.02","E66.9","Z68.35","F41.8","J45.30","E78.00","M19.012","M25.612","M75.00","M62.838","Z79.51","Z12.11","Z00.00","Z13.6","E78.2","M85.80","E66.09","E55.9"],"date":["2021-01-11","2021-01-11","2020-02-24","2020-03-11","2020-09-24","2021-01-11","2021-07-07","2020-08-06","2020-08-06","2020-12-10","2021-01-11","2020-12-10","2020-08-08","2021-03-01","2020-02-11","2020-12-10","2020-12-22","2020-12-22","2020-12-22","2021-03-01","2021-05-23","2020-09-28","2020-09-28","2020-09-28","2020-09-28","2020-09-28","2020-09-21"],"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":[["","00186037220","SYMBICORT ","80-4.5","10","Select","Select",""],["","00310737220","BUDES\/FORMOT ","80-4.5","-10","Select","Select",""],["","62332004590","VALSARTAN ","80MG","90","Select","Select",""],["","00006483703","PNEUMOVAX ","25\/0.5","0","Select","Select",""],["","49281012065","FLUZONE ","PF 20-21","1","Select","Select",""],["","13668008105","MONTELUKAST ","10MG","90","Select","Select",""],["","69315090405","LORAZEPAM ","0.5MG","14","Select","Select",""],["","00186037220","","80-4.5","10","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":""}]}]}