{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JACQUELINE HIGHTER-GUNT","gend":1,"add":"5200 SHADY GROVE LN","city":"VIRGINIA BEACH","state":"VA","zip":"23462-9998","dob":"1993-12-31","age":"","mstatus":"","insh":"900039660*01","cliId":"5DU3U43UJ91","pno":"757\/769-1824","cno":"757\/769-1824","email":"","ename":"","eno":"","pphy":"TANNOUS, GEORGE MD","ppno":"757\/673-5890","pcpadd":"SUITE 250 5818 HARBOR VIEW BLVD","pcpcity":"SUFFOLK","pcpstate":"VA","pcpzip":23435,"pcpcounty":"","pcpid":131856,"pcpname":"BON SECOURS MEDICAL ASSOCIATES","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"TIDEWATER","aligned":"Y","ano":"Non-DSNP","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F25.0","F43.10","F60.3","R73.01","D50.0","R11.2"],"date":["2021-09-03","2021-09-03","2021-09-03","2021-03-24","2021-03-24","2021-03-24"],"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":[["","55111025860","ZIPRASIDONE","CAP 60MG","30","Select","Select",""],["","43547027010","ROPINIROLE","TAB 1MG","30","Select","Select",""],["","904530780","BANOPHEN","CAP 50MG","30","Select","Select",""],["","67877024910","QUETIAPINE","TAB 50MG","30","Select","Select",""],["","50458056401","INVEGA SUST","INJ 234\/1.5","2","Select","Select",""],["","65162052111","PROMETHAZINE","TAB 25MG","10","Select","Select",""],["","43547029010","BUPROPION","TAB 200MG SR","30","Select","Select",""],["","70436001102","BUPROPN HCL","TAB 300MG XL","-30","Select","Select",""],["","68382011405","RISPERIDONE","TAB 1MG","30","Select","Select",""],["","50458056301","INVEGA SUSTENNA ","","1","Select","Select",""],["","67877024910","QUETIAPINE FUMARATE","","30","Select","Select",""],["","43547027010","ROPINIROLE HCL","","30","Select","Select",""],["","70436001102","BUPROPION HYDROCHLORIDE ER (XL) ","","-30","Select","Select",""],["","55111025960","ZIPRASIDONE HCL ","","-30","Select","Select",""],["","43547029010","BUPROPION HYDROCHLORIDE ER (SR) ","","30","Select","Select",""],["","65162052111","PROMETHAZINE HYDROCHLORIDE","","10","Select","Select",""],["","50458056401","INVEGA SUSTENNA","","2","Select","Select",""],["","60505253106","ZIPRASIDONE HCL","","30","Select","Select",""],["","70436001102","BUPROPION HYDROCHLORIDE ER (XL)","","-30","Select","Select",""],["","43547029010","BUPROPION HYDROCHLORIDE ER (SR)","","30","Select","Select",""],["","16714083801","ZIPRASIDONE HYDROCHLORIDE","80MG","30","Select","Select",""],["","50458056401","INVEGA SUSTENNA                                                       ","INJ 234\/1.5","2","Select","Select",""],["","67877024910","QUETIAPINE FUMARATE                                                   ","TAB 50MG","30","Select","Select",""],["","55111025860","ZIPRASIDONE HCL                                                       ","CAP 60MG","30","Select","Select",""],["","00904530780","BANOPHEN                                                              ","CAP 50MG","30","Select","Select",""],["","43547027050","ROPINIROLE HCL                                                        ","TAB 1MG","30","Select","Select",""],["","70436001102","BUPROPION HYDROCHLORIDE ER (XL)                                       ","TAB 300MG XL","-30","Select","Select",""],["","68382011405","RISPERIDONE                                                           ","TAB 1MG","30","Select","Select",""],["","43547029010","BUPROPION HYDROCHLORIDE ER (SR)                                       ","TAB 200MG SR","30","Select","Select",""],["","65162052111","PROMETHAZINE HYDROCHLORIDE                                            ","TAB 25MG","10","Select","Select",""],["","16714083801","ZIPRASIDONE HYDROCHLORIDE                                             ","CAP 80MG","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","",""],["No","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":""}]}]}