{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"FREDA   S BLAND","gend":1,"add":"15420 WILSON CT","city":"SMITHFIELD","state":"VA","zip":"23430-9998","dob":"1958-05-15","age":"","mstatus":"","insh":"900038822*01","cliId":"1MC0RJ1DK28","pno":"757\/755-4589","cno":"757\/755-4589","email":"","ename":"","eno":"","pphy":"BALKA, AMY E MD","ppno":"757\/238-7043","pcpadd":"13478 CARROLLTON BOULEVARD UNIT D &","pcpcity":"CARROLLTON","pcpstate":"VA","pcpzip":23314,"pcpcounty":"","pcpid":118380,"pcpname":"Eagle Harbor Primary Care","plan":"OHP","program":"MEDICARE","lob":"MA-Non DSNP","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/238-7052","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M05.9","Z51.81","Z79.899","M15.0","E55.9","I69.354","I10.","E78.2","M06.9","Z12.11","Z00.00","M62.81","R26.89","R68.89","Z13.820","Z78.0","Z12.31","M25.562","Z12.4","Z01.419","M17.12","K74.60","K75.4","R26.2","M25.561","H40.1231","H25.13"],"date":["2020-09-10","2020-09-10","2020-09-08","2020-03-04","2021-04-15","2020-07-06","2021-04-15","2021-04-15","2020-07-06","2020-07-23","2021-04-15","2020-03-06","2020-03-06","2020-02-03","2020-02-13","2020-02-13","2021-03-10","2021-09-07","2021-06-15","2021-06-15","2021-07-28","2021-08-06","2021-08-06","2021-09-07","2021-09-07","2021-09-09","2021-09-09"],"priorHcc":["","","","","","","","","","","","","","","","","",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":[["","68382009601","HYDROXYCHLOR ","200MG","60","Select","Select",""],["","68180072003","AMLODIPINE ","5MG","90","Select","Select",""],["","13668044201","CELECOXIB ","200MG","30","Select","Select",""],["","58160088552","FLUARIX ","2020-21","0","Select","Select",""],["","80777027399","MODERNA ","COVID-19","0","Select","Select",""],["","70377002911","ATORVASTATIN ","40MG","90","Select","Select",""],["","051672136307","DICLOFENAC ","3%","-100","Select","Select",""],["","68382009601","","200MG","-28","Select","Select",""],["","68382009601","HYDROXYCHLOR","200MG","60","Select","Select",""],["","68180072003","AMLODIPINE","5MG","90","Select","Select",""],["","13668044201","CELECOXIB","200MG","30","Select","Select",""],["","58160088552","FLUARIX","2020-21","0","Select","Select",""],["","80777027399","MODERNA","COVID-19","0","Select","Select",""],["","70377002911","ATORVASTATIN","40MG","90","Select","Select",""],["","51672136307","DICLOFENAC","3%","100","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":""}]}]}