{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ROSELYN   M DEMAREST","gend":1,"add":"130 GRINDSTONE TURN","city":"TABB","state":"VA","zip":"23693-9998","dob":"1933-08-05","age":"","mstatus":"","insh":"900036959*01","cliId":"4KD9VD0HP42","pno":"757\/814-1706","cno":"757\/814-1706","email":"","ename":"","eno":"","pphy":"DWYER, MEENAL D MD","ppno":"757\/594-4111","pcpadd":"12 BRUTON AVENUE","pcpcity":"NEWPORT NEWS","pcpstate":"VA","pcpzip":23601,"pcpcounty":"","pcpid":118380,"pcpname":"Bruton Avenue Family Practice","plan":"OHP","program":"MEDICARE","lob":"MA-NON DSNP","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/594-4115","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["C91.90","D64.81","Z79.899","R74.0","N18.2","R60.0","R91.1","J35.1","R13.10","D69.6","C91.10","E87.1","R74.8","R21.","I10.","T45.1X5S","R59.1","L27.0","Z87.19","D63.8","I12.9","N18.31","Z87.891","E78.00","F32.9","N30.00","R06.09","N18.3","R60.9","L30.9","R53.83","Z23.","D64.9","M25.512","M54.5","R33.9","L27.1","R59.0","M19.012","I25.10","Z00.00","F41.9","I65.22","E78.5","Z79.02","I08.2","K59.00","T45.1X5A","T45.1X5D","M15.9"],"date":["2021-03-11","2021-06-04","2021-06-04","2020-04-02","2021-06-04","2021-06-04","2021-04-09","2021-06-04","2020-04-02","2021-04-09","2021-06-11","2021-04-09","2021-04-09","2020-10-20","2020-12-15","2020-09-22","2021-04-09","2020-11-17","2020-10-20","2021-04-09","2021-03-18","2021-06-25","2021-03-18","2021-03-18","2021-03-18","2020-01-25","2020-06-23","2020-06-09","2020-09-18","2020-06-09","2020-06-09","2020-10-02","2021-01-12","2021-05-07","2021-05-07","2020-06-23","2021-03-11","2020-07-07","2021-05-07","2020-07-10","2020-09-18","2020-09-18","2020-02-14","2020-02-14","2020-02-14","2020-06-01","2021-06-11","2020-06-15","2021-03-11","2021-06-11"],"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":[["","57664051083","MIRTAZAPINE ","7.5MG","180","Select","Select",""],["","57962042028","IMBRUVICA ","420MG","28","Select","Select",""],["","57664050658","METOPROL ","25MG","90","Select","Select",""],["","00378632477","VALSART\/HCTZ ","320-12.5","90","Select","Select",""],["","33342032815","TRIAMCINOLON ","0.50%","30","Select","Select",""],["","68180071160","CEFDINIR ","300MG","20","Select","Select",""],["","00228212750","CLONIDINE ","0.1MG","180","Select","Select",""],["","70377002811","ATORVASTATIN ","20MG","90","Select","Select",""],["","51672127304","FLUOCINONIDE ","0.05%","-60","Select","Select",""],["","00093005805","TRAMADOL ","50MG","90","Select","Select",""],["","57664051083","","7.5MG","180","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","",""],["Yes","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":""}]}]}