{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" REGINA A SIERRA","gend":1,"add":"2113 ARDMORE AVE","city":"CHESAPEAKE","state":"VA","zip":"23324-9998","dob":"1969-01-15","age":"","mstatus":"","insh":"900040000*01","cliId":"","pno":"757\/348-4707","cno":"757\/348-4707, ","email":"","ename":"","eno":"","pphy":"BRAWLEY, JESSICA MD","ppno":"757\/312-6267","pcpadd":"908 EDEN WAY N STE 101","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":"23320-9998","pcpcounty":"","pcpid":164325,"pcpname":"","plan":"OHP - OPTIMA","program":"MEDICARE","lob":"MA-NON DSNP","region":"TIDEWATER","aligned":"","ano":"","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":["N31.9","N39.0","N39.3","Z79.899","G35.","M47.812","R90.82","Z12.31","R73.9","M21.371"],"date":["2021-03-04","2021-05-18","2021-01-25","2021-05-26","2021-05-27","2021-05-27","2021-05-27","2021-03-22","2021-05-03","2021-05-03"],"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":[["","67877044460","DALFAMPRIDIN ","10MG ER","60","Select","Select",""],["","68180052001","LISINOP\/HCTZ ","20-25MG","90","Select","Select",""],["","70461032003","FLUCLVX ","2020-21","0","Select","Select",""],["","65162037210","OXYBUTYNIN ","10MG ER","90","Select","Select",""],["","00378623201","CITALOPRAM ","20MG","90","Select","Select",""],["","58468021004","AUBAGIO ","14MG","-30","Select","Select",""],["","68462046160","TROSPIUM ","20MG","60","Select","Select",""],["","67877021905","CEPHALEXIN ","500MG","14","Select","Select",""],["","65162027250","SMZ\/TMP ","800-160","10","Select","Select",""],["","10144042760","AMPYRA ","10MG","60","Select","Select",""],["","00536396612","LOPERAMIDE ","2MG","30","Select","Select",""],["","70710112307","DOXYCYC ","100MG","10","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":""}]}]}