{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MICHAEL   A CHERRY","gend":0,"add":"901 GALE CT","city":"VIRGINIA BEACH","state":"VA","zip":"23464-9998","dob":"1985-01-16","age":"","mstatus":"","insh":"900036946*01","cliId":"5WF6PX3KF57","pno":"757\/748-5130","cno":"757\/748-5130","email":"","ename":"","eno":"","pphy":"TANNOUS, GEORGE MD","ppno":"757\/305-1797","pcpadd":"STE 220 828 HEALTHY WAY","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23462,"pcpcounty":"","pcpid":143824,"pcpname":"BON SECOURS MEDICAL ASSOCIATES","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"TIDEWATER","aligned":"Y","ano":"Non-DSNP","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/309-4715","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K51.90","D50.9","F84.0","F90.1","Z23.","Z11.59"],"date":["2020-10-13","2021-03-27","2021-09-20","2019-09-25","2021-08-24","2021-03-27"],"priorHcc":["",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":[["","76385010410","BENZTROPINE","TAB 1MG","28","Select","Select",""],["","49884090738","MEGESTROL AC","SUS 40MG\/ML","240","Select","Select",""],["","43547035011","PAROXETINE","TAB 40MG","15","Select","Select",""],["","60505257507","BALSALAZIDE","CAP 750MG","56","Select","Select",""],["","16729013616","CLONAZEPAM","TAB 0.5MG","56","Select","Select",""],["","27241000450","RISPERIDONE","TAB 2MG","28","Select","Select",""],["","68382071119","MESALAMINE","TAB 1.2GM","60","Select","Select",""],["","68382071119","MESALAMINE DR ","","56","Select","Select",""],["","76385010410","BENZTROPINE MESYLATE ","","28","Select","Select",""],["","60505009701","PAROXETINE HYDROCHLORIDE","","28","Select","Select",""],["","49884090738","MEGESTROL ACETATE","","240","Select","Select",""],["","60505257507","BALSALAZIDE DISODIUM ","","56","Select","Select",""],["","43547035011","PAROXETINE HCL","","28","Select","Select",""],["","68382071119","MESALAMINE DR","","-60","Select","Select",""],["","76385010410","BENZTROPINE MESYLATE","","28","Select","Select",""],["","60505257507","BALSALAZIDE DISODIUM","","56","Select","Select",""],["","68382071119","MESALAMINE DR                                                         ","TAB 1.2GM","56","Select","Select",""],["","60505009701","PAROXETINE HYDROCHLORIDE                                              ","TAB 10MG","28","Select","Select",""],["","68382011505","RISPERIDONE                                                           ","TAB 2MG","28","Select","Select",""],["","16729013616","CLONAZEPAM                                                            ","TAB 0.5MG","56","Select","Select",""],["","49884090738","MEGESTROL ACETATE                                                     ","SUS 40MG\/ML","240","Select","Select",""],["","60505257507","BALSALAZIDE DISODIUM                                                  ","CAP 750MG","19","Select","Select",""],["","76385010410","BENZTROPINE MESYLATE                                                  ","TAB 1MG","28","Select","Select",""],["","43547035011","PAROXETINE HCL                                                        ","TAB 40MG","28","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","",""],["No","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":""}]}]}