{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KEAUNNA   L STOKES","gend":1,"add":"13 HATCHER CT APT 223","city":"FARMVILLE","state":"VA","zip":"23901-9998","dob":"1992-03-20","age":"","mstatus":"","insh":"900040261*01","cliId":"9X46MU7GE65","pno":"434\/473-6925","cno":"434\/473-6925","email":"","ename":"","eno":"","pphy":"BASHORE, RANDALL T MD","ppno":"434\/581-3271","pcpadd":"RT 15 SOUTH","pcpcity":"NEW CANTON","pcpstate":"VA","pcpzip":23123,"pcpcounty":"","pcpid":105792,"pcpname":"","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"Non-DSNP","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/581-1105","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E10.10","N39.0","Z20.822","N17.9","F22.","E83.39","R74.01","H91.90","T38.3X6A","J45.909","R10.13","E86.0","E87.6","R53.1","E11.10","Z79.899","Z79.4"],"date":["2021-02-24","2021-02-24","2021-02-24","2021-04-15","2021-02-24","2021-02-24","2021-02-24","2021-02-24","2021-02-24","2021-04-15","2021-02-24","2021-02-24","2021-02-24","2021-04-15","2021-04-15","2021-04-15","2021-04-15"],"priorHcc":["","","",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":[["","53885027210","ONETOUCH","TES VERIO","400","Select","Select",""],["","65862042005","SMZ\/TMP DS","TAB 800-160","-10","Select","Select",""],["","8290320550","BD PEN NEEDL","MIS 32GX5\/32","100","Select","Select",""],["","88502005","LANTUS SOLOS","INJ 100\/ML","15","Select","Select",""],["","2751001","HUMALOG","INJ 100\/ML","10","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","2","Select","Select",""],["","2879959","HUMALOG KWIK","INJ 100\/ML","15","Select","Select",""],["","88222033","LANTUS","INJ 100\/ML","-30","Select","Select",""],["","8290328438","INSULIN SYRG","MIS 0.3\/31G","100","Select","Select",""],["","53885001110","ONETOUCH DEL","MIS PLUS 30G","100","Select","Select",""],["","53885027210","ONETOUCH VERIO TEST STRIPS","","400","Select","Select",""],["","2751001","HUMALOG ","","10","Select","Select",""],["","65862042005","SULFAMETHOXAZOLE\/TRIMETHOPRIM DS","","10","Select","Select",""],["","8290328438","BD INSULIN SYRINGE ULTRA-FINE\/0.3ML\/31G X 8MM ","","100","Select","Select",""],["","53885001110","ONETOUCH DELICA PLUS LANCETS FINE 30G ","","100","Select","Select",""],["","2879959","HUMALOG KWIKPEN ","","15","Select","Select",""],["","88502005","LANTUS SOLOSTAR ","","15","Select","Select",""],["","8290320550","BD PEN NEEDLE\/NANO 2ND GEN\/32G X 5\/32\"","","100","Select","Select",""],["","53885001110","ONETOUCH DELICA PLUS LANCETS FINE 30G","","100","Select","Select",""],["","08290328438","BD INSULIN SYRINGE ULTRA-FINE\/0.3ML\/31G X 8MM","","100","Select","Select",""],["","00088502005","LANTUS SOLOSTAR","","-15","Select","Select",""],["","00002879959","HUMALOG KWIKPEN","","15","Select","Select",""],["","65862042005","SULFAMETHOXAZOLE\/TRIMETHOPRIM DS                                      ","TAB 800-160","10","Select","Select",""],["","08290328438","BD INSULIN SYRINGE ULTRA-FINE\/0.3ML\/31G X 8MM                         ","MIS 0.3\/31G","100","Select","Select",""],["","53885027210","ONETOUCH VERIO TEST STRIPS                                            ","TES VERIO","400","Select","Select",""],["","00088222033","LANTUS                                                                ","INJ 100\/ML","10","Select","Select",""],["","53885001110","ONETOUCH DELICA PLUS LANCETS FINE 30G                                 ","MIS PLUS 30G","100","Select","Select",""],["","00002751001","HUMALOG                                                               ","INJ 100\/ML","-10","Select","Select",""],["","00088221905","LANTUS SOLOSTAR                                                       ","INJ 100\/ML","15","Select","Select",""],["","68180012202","CEPHALEXIN                                                            ","CAP 500MG","2","Select","Select",""],["","08290320550","BD PEN NEEDLE\/NANO 2ND GEN\/32G X 5\/32\"                                ","MIS 32GX5\/32","100","Select","Select",""],["","00002879959","HUMALOG KWIKPEN                                                       ","INJ 100\/ML","15","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":""}]}]}