{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DEBRA   C RAY","gend":1,"add":"105 WESTHAVEN DR","city":"DANVILLE","state":"VA","zip":"24541-9998","dob":"1954-10-19","age":"","mstatus":"","insh":"900039329*01","cliId":"1G76HY6XQ48","pno":"910\/279-5102","cno":"910\/279-5102","email":"","ename":"","eno":"","pphy":"WINFIELD, ALBERT C MD","ppno":"434\/791-4110","pcpadd":"173 EXECUTIVE DRIVE","pcpcity":"DANVILLE","pcpstate":"VA","pcpzip":24541,"pcpcounty":"","pcpid":134296,"pcpname":"","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"Y","ano":"Non-DSNP","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/791-4003","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R92.8","R73.02","L65.9","I10.","E78.00","Z00.01","E78.5","E55.9","E53.8","E87.5","R92.2","I25.10","F41.9","M17.11","M17.12","M25.561","Z68.35","Z79.899","Z13.89"],"date":["2021-07-15","2021-07-26","2020-09-11","2021-06-23","2021-06-23","2021-03-09","2021-07-15","2021-03-03","2021-03-03","2021-03-03","2021-01-28","2021-07-15","2021-02-23","2021-04-27","2021-04-27","2021-04-14","2021-03-09","2021-03-09","2021-03-09"],"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":[["","68180051901","LISINOP\/HCTZ","TAB 20-12.5","90","Select","Select",""],["","70377000612","ROSUVASTATIN","TAB 5MG","15","Select","Select",""],["","93321205","CLONAZEPAM","TAB 1MG","30","Select","Select",""],["","76385011250","CARVEDILOL","TAB 12.5MG","180","Select","Select",""],["","51672127304","FLUOCINONIDE","SOL 0.0005","-60","Select","Select",""],["","42858010201","OXYCOD\/APAP","TAB 5-325MG","12","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","30","Select","Select",""],["","116200116","CHLORHEX GLU","SOL 0.0012","473","Select","Select",""],["","68180051901","LISINOPRIL\/HYDROCHLOROTHIAZIDE","","90","Select","Select",""],["","42858010201","OXYCODONE\/ACETAMINOPHEN","","12","Select","Select",""],["","116200116","CHLORHEXIDINE GLUCONATE","","473","Select","Select",""],["","70377000612","ROSUVASTATIN CALCIUM ","","15","Select","Select",""],["","70377000612","ROSUVASTATIN CALCIUM","","-45","Select","Select",""],["","68180098103","LISINOPRIL","","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":""}]}]}