{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MICHAEL   S WALLS","gend":0,"add":"57 PINETTA DR","city":"HUDGINS","state":"VA","zip":"23076-9998","dob":"1960-04-18","age":"","mstatus":"","insh":"900037809*01","cliId":"2N53E66AU09","pno":"804\/921-0858","cno":"804\/921-0858","email":"","ename":"","eno":"","pphy":"LARUE, JAMES C MD","ppno":"804\/725-5005","pcpadd":"10976 BUCKLEY HALL ROAD","pcpcity":"MATHEWS","pcpstate":"VA","pcpzip":23109,"pcpcounty":"","pcpid":118380,"pcpname":"Riverside Mathews Medical Center","plan":"OHP","program":"MEDICARE","lob":"MA-NON DSNP","region":"CENTRAL","aligned":"","ano":"804\/366-1727","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/725-3204","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M75.122","I10.","J44.9","G47.30","G89.18","M25.512","R20.0","R53.83","E03.9","M79.18","G47.33","N20.0","Z87.442","R42.","Z23.","M12.812","T78.49XA","M54.2","M54.5","G89.29","S46.012A","S46.212A","L72.0","M62.50","Z98.890","Z12.11","R29.3","Z47.89","R39.11","S46.012D","M19.90","I25.10","E07.9","L72.3","E78.5","E29.1","N52.9","Z12.5","S81.812A","M19.012","R20.2","R29.2","Z98.1","M48.02","M54.16","R39.15","Z20.828","M47.812","M46.90","Z00.00","E34.9","M47.22","M51.16","M47.26","M51.36","R19.5"],"date":["2020-12-01","2020-12-01","2021-01-07","2021-01-07","2020-12-01","2021-03-04","2021-01-07","2020-12-31","2020-12-31","2021-07-06","2020-03-06","2021-05-19","2020-05-26","2020-09-30","2020-09-30","2020-12-01","2020-12-01","2021-05-25","2021-05-25","2021-05-25","2020-01-07","2020-01-07","2020-02-20","2020-06-16","2020-06-16","2021-05-19","2020-02-21","2020-05-26","2020-05-26","2021-03-03","2021-01-07","2021-01-07","2021-01-07","2020-02-20","2020-04-02","2020-04-02","2021-05-19","2021-05-21","2020-11-02","2020-12-01","2021-04-02","2021-04-02","2021-07-06","2021-05-04","2021-07-02","2021-05-19","2021-06-13","2021-04-02","2021-04-02","2020-04-10","2020-04-10","2021-04-02","2021-07-02","2021-07-02","2021-07-06","2021-07-27"],"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":[["","00143965901","TESTOST ","200MG\/ML","6","Select","Select",""],["","08290309588","3ML ","23GX1\"","7","Select","Select",""],["","00406012405","HYDROCO\/APAP ","7.5-325","30","Select","Select",""],["","61442010310","DICLOFENAC ","75MG DR","-60","Select","Select",""],["","57664022388","OXYCODONE ","5MG","30","Select","Select",""],["","68462026430","ROSUVASTATIN ","40MG","30","Select","Select",""],["","16729018317","HYDROCHLOROT ","25MG","90","Select","Select",""],["","69238183307","LEVOTHYROXIN ","88MCG","90","Select","Select",""],["","13668000810","ZOLPIDEM ","10MG","90","Select","Select",""],["","65162044210","MECLIZINE ","25MG","30","Select","Select",""],["","68462015713","ONDANSETRON ","4MG ODT","20","Select","Select",""],["","00172392660","DIAZEPAM ","5MG","2","Select","Select",""],["","013668018701","SILDENAFIL ","50MG","60","Select","Select",""],["","43386009019","GAVILYTE-G ","","-4000","Select","Select",""],["","10572010001","PEG-3350 ","ELECTROL","4000","Select","Select",""],["","00143965901","TESTOST","200MG\/ML","6","Select","Select",""],["","00143965901","","200MG\/ML","6","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":""}]}]}