{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SHEKIA   O BRADLEY","gend":1,"add":"538 PINELAND CIR APT 102","city":"NEWPORT NEWS","state":"VA","zip":"23608-9998","dob":"1986-05-03","age":"","mstatus":"","insh":"900039543*01","cliId":"2NC3UW1DP71","pno":"757\/236-4163","cno":"757\/236-4163","email":"","ename":"","eno":"","pphy":"GRAHAM JR, LEROY MD","ppno":"757\/890-0012","pcpadd":"15408 WARWICK BLVD","pcpcity":"NEWPORT NEWS","pcpstate":"VA","pcpzip":23608,"pcpcounty":"","pcpid":129522,"pcpname":"","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"TIDEWATER","aligned":"Y","ano":"Non-DSNP","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/890-0013","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N93.0","A49.3","B96.89","R30.0","N89.8","R10.2","Z11.51","E11.65","E66.01","E78.2","I10.","Z72.0","Z68.39","Z00.00","Z72.51","Z68.41","Z01.419","Z11.3","E11.9","F17.210","Z79.899","Z79.84","N92.1","N39.0"],"date":["2021-01-28","2021-01-28","2021-01-28","2021-06-15","2021-08-30","2021-01-28","2020-06-29","2021-10-11","2021-10-11","2021-10-11","2021-10-11","2021-10-11","2021-10-11","2021-10-11","2021-04-05","2021-08-30","2020-06-29","2020-11-22","2020-11-22","2020-11-22","2020-11-22","2020-11-22","2020-06-29","2021-06-15"],"priorHcc":["","","","",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":[["","68180065208","DOXYCYC MONO","CAP 100MG","-24","Select","Select",""],["","6027731","JANUVIA","TAB 100MG","30","Select","Select",""],["","68382076010","METFORMIN","TAB 1000MG","180","Select","Select",""],["","99073070822","FREESTYLE","TES LITE","-300","Select","Select",""],["","60505265601","TRIAMT\/HCTZ","TAB 37.5-25","90","Select","Select",""],["","70377002711","ATORVASTATIN","TAB 10MG","-90","Select","Select",""],["","68382002210","ATENOLOL","TAB 25MG","90","Select","Select",""],["","6008061","JANUMET XR","TAB 50-1000","90","Select","Select",""],["","69452023420","PROGESTERONE","CAP 200MG","-21","Select","Select",""],["","70710113908","FLUCONAZOLE","TAB 150MG","-1","Select","Select",""],["","63304069301","CLINDAMYCIN","CAP 300MG","14","Select","Select",""],["","6027731","JANUVIA ","","60","Select","Select",""],["","63304069301","CLINDAMYCIN HCL ","","14","Select","Select",""],["","68180065208","DOXYCYCLINE MONOHYDRATE","","-24","Select","Select",""],["","68382076010","METFORMIN HYDROCHLORIDE","","180","Select","Select",""],["","99073070827","FREESTYLE LITE TEST STRIPS","","-300","Select","Select",""],["","60505265601","TRIAMTERENE\/HYDROCHLOROTHIAZIDE ","","90","Select","Select",""],["","70377002711","ATORVASTATIN CALCIUM ","","90","Select","Select",""],["","63304069301","CLINDAMYCIN HCL","","14","Select","Select",""],["","60505265601","TRIAMTERENE\/HYDROCHLOROTHIAZIDE","","90","Select","Select",""],["","70377002711","ATORVASTATIN CALCIUM","","90","Select","Select",""],["","68180012202","CEPHALEXIN","","10","Select","Select",""],["","50111033401","METRONIDAZOLE","500MG","14","Select","Select",""],["","68382002210","ATENOLOL                                                              ","TAB 25MG","90","Select","Select",""],["","63304069301","CLINDAMYCIN HCL                                                       ","CAP 300MG","14","Select","Select",""],["","68180065208","DOXYCYCLINE MONOHYDRATE                                               ","CAP 100MG","-24","Select","Select",""],["","00006027731","JANUVIA                                                               ","TAB 100MG","30","Select","Select",""],["","68382076010","METFORMIN HYDROCHLORIDE                                               ","TAB 1000MG","180","Select","Select",""],["","00006008061","JANUMET XR                                                            ","TAB 50-1000","90","Select","Select",""],["","60505265601","TRIAMTERENE\/HYDROCHLOROTHIAZIDE                                       ","TAB 37.5-25","90","Select","Select",""],["","70710113908","FLUCONAZOLE                                                           ","TAB 150MG","1","Select","Select",""],["","99073070822","FREESTYLE LITE TEST STRIPS                                            ","TES LITE","300","Select","Select",""],["","70377002711","ATORVASTATIN CALCIUM                                                  ","TAB 10MG","90","Select","Select",""],["","69452023420","PROGESTERONE                                                          ","CAP 200MG","7","Select","Select",""],["","68180012202","CEPHALEXIN                                                            ","CAP 500MG","10","Select","Select",""],["","50111033401","METRONIDAZOLE                                                         ","TAB 500MG","14","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","",""],["No","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":""}]}]}