{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DOROTHY   L WASHINGTON","gend":1,"add":"1910 HOWARD AVE","city":"FREDERICKSBURG","state":"VA","zip":"22401-9998","dob":"1946-06-04","age":"","mstatus":"","insh":"900037132*01","cliId":"1X48TW6VE46","pno":"540\/372-3478","cno":"540\/372-3478","email":"","ename":"","eno":"","pphy":"ADAMS, SELWYN MD","ppno":"540\/374-1188","pcpadd":"2301 FALL HILL AVE","pcpcity":"FREDERICKSBURG","pcpstate":"VA","pcpzip":22401,"pcpcounty":"","pcpid":101777,"pcpname":"","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"Non-DSNP","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"540\/372-9679","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E11.65","I10.","Z12.11","E11.9","I69.351","E78.5","I11.9","I25.10","I25.2","J45.40","E66.9","J30.9","Z68.34","Z79.51","R06.09","E66.8","Z85.20","Z12.31","Z85.118","R40.0","C34.30","C34.32","R59.0","H17.9","C34.92","R26.2","E03.9","E78.2","N17.2","E11.42","Z86.73","M20.42","M20.41","Z01.810","M79.642","E78.89"],"date":["2021-07-21","2021-08-17","2021-05-23","2021-03-30","2020-12-13","2021-03-30","2020-12-13","2021-08-17","2020-12-13","2020-12-13","2020-12-13","2020-12-13","2020-12-13","2020-12-13","2020-01-23","2020-01-21","2020-01-23","2020-07-13","2021-05-11","2020-01-23","2020-01-23","2020-01-23","2020-01-24","2020-05-13","2021-05-13","2020-01-29","2020-08-05","2021-08-17","2021-05-21","2021-05-18","2021-05-18","2021-05-18","2021-05-18","2021-08-17","2021-08-02","2021-07-21"],"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":[["","63304082990","ATORVASTATIN","TAB 40MG","30","Select","Select",""],["","65162044210","MECLIZINE","TAB 25MG","90","Select","Select",""],["","65862052405","GABAPENTIN","TAB 800MG","90","Select","Select",""],["","228212850","CLONIDINE","TAB 0.2MG","60","Select","Select",""],["","23155010305","METFORMIN","TAB 850MG","60","Select","Select",""],["","23155000401","HYDRALAZINE","TAB 100MG","270","Select","Select",""],["","24208063562","NEO\/POLY\/HC","SUS 1% OTIC","10","Select","Select",""],["","13668008105","MONTELUKAST","TAB 10MG","30","Select","Select",""],["","31722053001","TORSEMIDE","TAB 10MG","90","Select","Select",""],["","68382079801","LABETALOL","TAB 100MG","360","Select","Select",""],["","406048401","APAP\/CODEINE","TAB 300-30MG","120","Select","Select",""],["","173068220","VENTOLIN HFA","AER ","18","Select","Select",""],["","173085910","BREO ELLIPTA","INH 100-25","60","Select","Select",""],["","67877019905","AMLODIPINE","TAB 10MG","30","Select","Select",""],["","57237015701","REPAGLINIDE","TAB 0.5MG","90","Select","Select",""],["","3089421","ELIQUIS","TAB 5MG","60","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","36","Select","Select",""],["","13668008190","MONTELUKAST SODIUM ","","30","Select","Select",""],["","61314064511","NEOMYCIN\/POLYMYXIN\/HYDROCORTISONE ","","10","Select","Select",""],["","23155000401","HYDRALAZINE HYDROCHLORIDE ","","270","Select","Select",""],["","228212850","CLONIDINE HYDROCHLORIDE","","60","Select","Select",""],["","65162044210","MECLIZINE HYDROCHLORIDE","","90","Select","Select",""],["","23155010305","METFORMIN HYDROCHLORIDE","","60","Select","Select",""],["","60505258009","ATORVASTATIN CALCIUM ","","30","Select","Select",""],["","68382079801","LABETALOL HYDROCHLORIDE","","360","Select","Select",""],["","66993001968","ALBUTEROL SULFATE HFA","","36","Select","Select",""],["","67877019905","AMLODIPINE BESYLATE","","30","Select","Select",""],["","31722053001","TORSEMIDE ","","90","Select","Select",""],["","3089421","ELIQUIS ","","60","Select","Select",""],["","406048401","ACETAMINOPHEN\/CODEINE","","120","Select","Select",""],["","61314064511","NEOMYCIN\/POLYMYXIN\/HYDROCORTISONE","","10","Select","Select",""],["","13668008190","MONTELUKAST SODIUM","","30","Select","Select",""],["","23155000401","HYDRALAZINE HYDROCHLORIDE","","-270","Select","Select",""],["","60505258009","ATORVASTATIN CALCIUM","","30","Select","Select",""],["","68382065101","ISOSORBIDE MONONITRATE ER","60MG ER","90","Select","Select",""],["","67877021905","CEPHALEXIN","500MG","8","Select","Select",""],["","71930004512","OXYCODONE\/ACETAMINOPHEN","5-325MG","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":[[["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":""}]}]}