{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DOUGLAS   A GREENE","gend":0,"add":"4549 EASTSIDE HWY","city":"GROTTOES","state":"VA","zip":"24441-9998","dob":"1970-02-07","age":"","mstatus":"","insh":"900040187*01","cliId":"6DJ4T34UU81","pno":"540\/820-4664","cno":"540\/820-4664","email":"","ename":"","eno":"","pphy":"LA GRUA, JAMES C DO","ppno":"540\/248-3413","pcpadd":"1371 LEE HIGHWAY","pcpcity":"VERONA","pcpstate":"VA","pcpzip":24482,"pcpcounty":"","pcpid":973007,"pcpname":"Carilion Family Medicine Fort Defiance","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"Y","ano":"Non-DSNP","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"540\/248-8413","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M54.12","R11.2","R10.13","I10.","Z85.9","R10.9","C09.9","R13.10","C76.0","Z85.818","Z92.3","R20.2","R53.83","R59.0","H20.10","H11.431"],"date":["2021-07-15","2021-07-24","2021-07-24","2021-07-24","2021-07-24","2021-07-24","2021-08-10","2021-08-10","2021-07-30","2021-08-10","2021-07-30","2021-07-15","2021-07-15","2021-08-10","2021-10-11","2021-09-23"],"priorHcc":["","","","","","","","","","","","","","",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":[["","57237007710","ONDANSETRON ODT","4MG ODT","10","Select","Select",""],["","47781065710","LEVOTHYROXINE SODIUM","125MCG","90","Select","Select",""],["","52817033200","CYCLOBENZAPRINE HYDROCHLORIDE","10MG","30","Select","Select",""],["","00781502207","METHYLPREDNISOLONE DOSE PACK","4MG","21","Select","Select",""],["","60758011915","PREDNISOLONE ACETATE","1% OP","15","Select","Select",""],["","17478021502","ATROPINE SULFATE","1% OP","2","Select","Select",""],["","00781502207","METHYLPREDNISOLONE DOSE PACK                                          ","TAB 4MG","21","Select","Select",""],["","52817033200","CYCLOBENZAPRINE HYDROCHLORIDE                                         ","TAB 10MG","30","Select","Select",""],["","60758011915","PREDNISOLONE ACETATE                                                  ","SUS 1% OP","15","Select","Select",""],["","57237007710","ONDANSETRON ODT                                                       ","TAB 4MG ODT","10","Select","Select",""],["","17478021502","ATROPINE SULFATE                                                      ","SOL 1% OP","2","Select","Select",""],["","47781065710","LEVOTHYROXINE SODIUM                                                  ","TAB 125MCG","90","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":""}]}]}