{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DEBRA   G LANDRY","gend":1,"add":"551 JASPER LN","city":"WAVERLY","state":"VA","zip":"23890-9998","dob":"1952-12-21","age":"","mstatus":"","insh":"900038288*01","cliId":"9U47MK2CR46","pno":"757\/753-1233","cno":"757\/753-1233","email":"","ename":"","eno":"","pphy":"COLEMAN, GEORGE C MD","ppno":"804\/834-8871","pcpadd":"344 WEST MAIN ST","pcpcity":"WAVERLY","pcpstate":"VA","pcpzip":23890,"pcpcounty":"","pcpid":671580,"pcpname":"","plan":"OHP","program":"MEDICARE","lob":"MA-Non DSNP","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/834-8875","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E11.9","M47.816","I10.","N18.3","F41.8","E78.9","K58.9","B37.2","Z68.42","N18.30","H04.123","H02.402","L71.8","H25.13","R32.","K21.9","Z11.59","G47.9","N39.0","Z68.43","R05.","Z12.11","Z20.822","M54.2","M25.551","M79.662","Z79.4","H43.813"],"date":["2021-09-16","2021-08-26","2021-08-26","2020-08-17","2021-08-26","2021-08-26","2021-08-26","2021-06-17","2021-06-07","2021-05-27","2021-09-16","2021-09-16","2021-09-16","2021-09-16","2021-08-26","2021-08-26","2021-04-07","2021-05-27","2020-05-22","2020-08-17","2021-02-22","2021-07-07","2021-11-11","2021-06-17","2021-06-17","2021-06-17","2021-09-16","2021-09-16"],"priorHcc":[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":[["","72205002790","ROSUVASTATIN ","5MG","25","Select","Select",""],["","60258016201","RENAL ","","90","Select","Select",""],["","57237001830","DULOXETINE ","30MG","-270","Select","Select",""],["","68645055654","LISINOP\/HCTZ ","10-12.5","-90","Select","Select",""],["","64764017130","DEXILANT ","30MG DR","-90","Select","Select",""],["","16714073302","CELECOXIB ","200MG","90","Select","Select",""],["","00169406012","VICTOZA ","18MG\/3ML","6","Select","Select",""],["","58160082311","SHINGRIX ","50\/0.5ML","1","Select","Select",""],["","00024586903","TOUJEO ","300IU\/ML","14","Select","Select",""],["","08290320122","BD  PEN NEEDL","32GX4MM","200","Select","Select",""],["","91237000128","ALCOHOL ","","-100","Select","Select",""],["","00591079510","DICYCLOMINE ","20MG","90","Select","Select",""],["","57237023305","SMZ-TMP ","800-160","14","Select","Select",""],["","00469260230","MYRBETRIQ ","50MG","90","Select","Select",""],["","00168009930","KETOCONAZOLE ","2%","60","Select","Select",""],["","69543026010","VIRT-CAPS ","","90","Select","Select",""],["","90166011103","GLOBAL ","PADS","100","Select","Select",""],["","00054418125","DEXAMETHASON ","1MG","1","Select","Select",""],["","00115148361","DICLOFENAC ","3%","100","Select","Select",""],["","13811052501","TRIPHROCAPS ","","90","Select","Select",""],["","021292000908","","","200","Select","Select",""],["","056151146304","TRUE ","GLUCOSE","100","Select","Select",""],["","57237001830","DULOXETINE","30MG","-180","Select","Select",""],["","64764017130","DEXILANT","30MG DR","-90","Select","Select",""],["","00024586903","TOUJEO","300IU\/ML","-14","Select","Select",""],["","16714073302","CELECOXIB","200MG","90","Select","Select",""],["","60258016201","RENAL","","90","Select","Select",""],["","00169406012","VICTOZA","18MG\/3ML","6","Select","Select",""],["","08290320122","BD PEN NEEDL","32GX4MM","-200","Select","Select",""],["","68645055654","LISINOP\/HCTZ","10-12.5","90","Select","Select",""],["","58160082311","SHINGRIX","50\/0.5ML","1","Select","Select",""],["","72205002790","ROSUVASTATIN","5MG","25","Select","Select",""],["","91237000128","ALCOHOL","","100","Select","Select",""],["","00591079510","DICYCLOMINE","20MG","90","Select","Select",""],["","57237023305","SMZ-TMP","800-160","14","Select","Select",""],["","00469260230","MYRBETRIQ","50MG","90","Select","Select",""],["","00168009930","KETOCONAZOLE","2%","60","Select","Select",""],["","90166011103","GLOBAL","PADS","100","Select","Select",""],["","13811052501","TRIPHROCAPS","","90","Select","Select",""],["","00054418125","DEXAMETHASON","1MG","1","Select","Select",""],["","00115148361","DICLOFENAC","3%","100","Select","Select",""],["","56151146304","TRUE","GLUCOSE","100","Select","Select",""],["","53885065701","ONETOUCH","VERIO","-1","Select","Select",""],["","53885004401","ONE","VERIO FL","1","Select","Select",""],["","69543026010","VIRT-CAPS","","90","Select","Select",""],["","53885014301","ONETOUCH ","MIS LANCETS","100","Select","Select",""],["","53885004401","ONE ","KIT VERIO FL","1","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":""}]}]}