{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DONNA   J CLASS","gend":1,"add":"5105 HOFFLER ST","city":"SUFFOLK","state":"VA","zip":"23435-9998","dob":"1949-09-08","age":"","mstatus":"","insh":"900038237*01","cliId":"","pno":"757\/759-8337","cno":"757\/759-8337, ","email":"","ename":"","eno":"","pphy":"BAINES, ROBIN S MD","ppno":"757\/726-5000","pcpadd":"200 EATON ST","pcpcity":"HAMPTON","pcpstate":"VA","pcpzip":23669,"pcpcounty":"","pcpid":101284,"pcpname":"SMG - Sentara Family & Internal Medicine Physicians - Williamsburg","plan":"OHP","program":"MEDICARE","lob":"MA-Non DSNP","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/726-5001","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R55.","R53.83","R06.02","Z86.19","Z23.","Z68.35","M51.36","R42.","Z86.73","R07.9","R29.898","R77.8","I63.9","I50.31","R47.01","E66.09","R26.2","I10.","R53.1","I16.0","E87.6","C50.411","M62.81","I21.4","I48.92","I34.0","I48.0","E78.5","E86.0","R06.00","Z01.419","F33.9","E55.9","Z85.3","Z90.11","I49.1","R73.9","Z68.34","M54.41","R26.89","J34.89","Z68.32","Z17.0","I51.7","Z12.11","I50.30","I65.23","M47.26","G45.9","I69.398","I11.0","I47.1","Z00.00","R31.21","L98.9","L60.0","R29.818","I67.82","N39.490","M48.02","M47.812","H74.8X2","R20.0","Z12.31","R03.0","I49.3","Z74.3","K21.9","R25.2","I63.81","I16.1","E66.9","I95.9","M19.90","Z90.12","Z92.21","R94.31","R20.2"],"date":["2021-11-05","2020-11-13","2021-08-19","2020-11-13","2020-11-13","2020-11-13","2021-05-18","2021-11-03","2021-11-03","2021-11-03","2021-07-03","2021-07-06","2021-08-01","2021-07-06","2021-07-06","2021-07-06","2021-07-06","2021-08-19","2021-08-01","2021-07-06","2021-07-12","2021-07-06","2021-07-21","2021-08-19","2021-08-19","2021-08-19","2021-10-29","2021-07-13","2021-11-03","2021-11-03","2021-03-26","2021-03-26","2021-03-26","2021-07-03","2021-07-01","2021-03-26","2021-03-26","2021-05-18","2021-06-08","2021-06-08","2021-07-01","2021-07-01","2021-07-03","2021-11-04","2021-05-23","2020-12-10","2020-12-10","2021-05-12","2021-07-06","2021-07-21","2021-07-21","2021-08-19","2020-04-14","2021-05-18","2021-05-18","2021-05-18","2021-07-01","2021-06-27","2021-07-03","2021-07-03","2021-07-03","2021-07-03","2021-08-01","2021-04-07","2021-07-01","2021-07-03","2021-08-01","2021-07-12","2020-09-23","2021-07-01","2021-07-01","2021-07-01","2021-07-01","2021-07-01","2021-07-01","2021-07-01","2021-07-02","2021-08-01"],"priorHcc":[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,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":[["","65862052830","VENLAFAXINE ","CAP 75MG ER","90","Select","Select",""],["","68645057054","CITALOPRAM ","TAB 20MG","90","Select","Select",""],["","00003089421","ELIQUIS ","TAB 5MG","-60","Select","Select",""],["","00093505898","ATORVASTATIN ","TAB 40MG","30","Select","Select",""],["","68645055254","LISINOPRIL ","TAB 10MG","90","Select","Select",""],["","00904404073","ASPIRIN ","CHW 81MG","30","Select","Select",""],["","16714084501","AMIODARONE ","TAB 400MG","3","Select","Select",""],["","68462063945","NITROGLYCERN ","SUB 0.4MG","25","Select","Select",""],["","00245014760","PACERONE ","TAB 200MG","30","Select","Select",""],["","16714008110","HYDROXYZ ","TAB 10MG","90","Select","Select",""],["","50458057990","XARELTO ","TAB 20MG","30","Select","Select",""],["","68645059090","CLOPIDOGREL ","TAB 75MG","30","Select","Select",""],["","52817036000","METOPROL ","TAB 25MG","30","Select","Select",""],["","60258017101","MAG ","TAB 400MG","30","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":""}]}]}