{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" KATHERINE A WHITE","gend":1,"add":"9 SIMPLICITY ROAD","city":"KEYSVILLE","state":"VA","zip":"23947-9998","dob":"1936-04-23","age":"","mstatus":"","insh":"900038117*01","cliId":"","pno":"434\/736-8043","cno":"434\/736-8043, ","email":"","ename":"","eno":"","pphy":"PRUITT, DAVID E MD","ppno":"434\/315-5340","pcpadd":"935 SOUTH MAIN STREET","pcpcity":"FARMVILLE","pcpstate":"VA","pcpzip":"23901-9998","pcpcounty":"","pcpid":182209,"pcpname":"","plan":"OHP - OPTIMA","program":"MEDICARE","lob":"MA-NON DSNP","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I21.4","R94.31","E87.1","E83.42","E87.6","I95.9","R06.02","I25.10","R94.39","I10.","S92.355B","R82.71","R58.","G56.92","Z78.9","E66.9","G56.02","G56.10","Z87.891","E78.2","N32.81","F41.9","Z68.38","M25.511","E78.5","M79.601","I26.99","R42.","R53.1","I21.9","H40.1212","H40.1221","Z96.1","R79.89","Z91.81","Z76.89","S92.352A","I99.8","K59.00","N39.0","E53.8","E55.9","Z68.35","E86.9","K21.9","S92.355A","T50.2X5A","Z79.82","Z79.899","R20.2"],"date":["2020-02-26","2020-01-18","2021-01-11","2021-01-11","2021-03-24","2020-01-16","2020-01-16","2021-03-24","2020-01-16","2021-03-24","2020-01-18","2020-01-18","2020-02-06","2020-05-20","2021-01-18","2021-01-18","2021-01-18","2021-01-18","2020-12-02","2021-01-18","2021-01-18","2021-01-18","2021-01-18","2021-04-15","2021-03-24","2021-03-24","2020-01-13","2020-01-13","2020-01-13","2020-01-14","2021-04-28","2021-04-28","2021-04-28","2020-07-13","2020-03-10","2020-01-08","2020-02-03","2020-02-06","2020-02-06","2020-02-06","2020-02-06","2020-07-13","2020-07-13","2020-01-13","2020-01-13","2020-01-13","2020-01-13","2020-01-13","2020-01-13","2020-07-02"],"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":[["","60505267108","ATORVASTATIN ","80MG","30","Select","Select",""],["","37205083340","MILK ","400\/5ML","355","Select","Select",""],["","55111046705","METOPROL ","50MG ER","30","Select","Select",""],["","23155051905","ISOSORB ","30MG ER","30","Select","Select",""],["","16729021816","CLOPIDOGREL ","75MG","30","Select","Select",""],["","45802006405","TRIAMCINOLON ","0.10%","30","Select","Select",""],["","42571014126","DORZOLAMIDE ","2% OP","10","Select","Select",""],["","70954000520","OXYBUTYNIN ","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","",""],["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":""}]}]}