{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KESHIRA   R REED","gend":1,"add":"1118 VIRGINIA AVE APT B","city":"PORTSMOUTH","state":"VA","zip":"23707-9998","dob":"1996-03-16","age":"","mstatus":"","insh":"900040055*01","cliId":"4DQ1KT7KF15","pno":"757\/359-6850","cno":"757\/359-6850","email":"","ename":"","eno":"","pphy":"YUNAS, MOHAMMAD MD","ppno":"393-6595","pcpadd":"3003 HIGH ST","pcpcity":"PORTSMOUTH","pcpstate":"VA","pcpzip":23707,"pcpcounty":"","pcpid":200302,"pcpname":"","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"TIDEWATER","aligned":"Y","ano":"Non-DSNP","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/393-9584","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J30.9","J45.909","F31.32","A60.00","F41.9","F32.9","F20.9"],"date":["2021-03-31","2021-03-31","2021-04-01","2021-03-03","2021-03-03","2021-03-03","2021-07-25"],"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":[["","591365930","DESVENLAFAX","TAB 50MG ER","30","Select","Select",""],["","16714008212","HYDROXYZ HCL","TAB 25MG","45","Select","Select",""],["","59310057922","PROAIR HFA","AER ","8","Select","Select",""],["","16714079904","CETIRIZINE","TAB 10MG","30","Select","Select",""],["","173068220","VENTOLIN HFA","AER ","18","Select","Select",""],["","115180301","HYDROXYZ PAM","CAP 25MG","90","Select","Select",""],["","50383070016","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","16714008212","HYDROXYZINE HYDROCHLORIDE ","","45","Select","Select",""],["","16714079904","CETIRIZINE HYDROCHLORIDE","","30","Select","Select",""],["","50383070016","FLUTICASONE PROPIONATE","","16","Select","Select",""],["","115180301","HYDROXYZINE PAMOATE","","90","Select","Select",""],["","591365930","DESVENLAFAXINE ER","","30","Select","Select",""],["","16714008212","HYDROXYZINE HYDROCHLORIDE","","45","Select","Select",""],["","16714079904","CETIRIZINE HYDROCHLORIDE                                              ","TAB 10MG","30","Select","Select",""],["","00173068220","VENTOLIN HFA                                                          ","AER ","18","Select","Select",""],["","00591365930","DESVENLAFAXINE ER                                                     ","TAB 50MG ER","30","Select","Select",""],["","00115180301","HYDROXYZINE PAMOATE                                                   ","CAP 25MG","90","Select","Select",""],["","50383070016","FLUTICASONE PROPIONATE                                                ","SPR 50MCG","16","Select","Select",""],["","16714008212","HYDROXYZINE HYDROCHLORIDE                                             ","TAB 25MG","45","Select","Select",""],["","59310057922","PROAIR HFA                                                            ","AER ","8","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":""}]}]}