{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DARLENE   B BYRD","gend":1,"add":"17 DOVER CT APT 4","city":"SPRING GROVE","state":"VA","zip":"23881-9998","dob":"1963-04-22","age":"","mstatus":"","insh":"900040354*01","cliId":"1AX3PA1MC70","pno":"757\/647-9824","cno":"757\/647-9824","email":"","ename":"","eno":"","pphy":"MASON, JESSICA A MD","ppno":"757\/484-5828","pcpadd":"7185 HARBOUR TOWNE PKWY SUITE 206","pcpcity":"SUFFOLK","pcpstate":"VA","pcpzip":23435,"pcpcounty":"","pcpid":174757,"pcpname":"INTERNISTS OF CHURCHLAND","plan":"OHP","program":"MEDICARE","lob":"MA-Non DSNP","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/484-4933","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z93.3","E78.5","R73.03","K46.9","Z68.39","E06.3","R76.8","H90.3","M47.896","M54.5","Z04.1","S39.012A","V87.7XXA","Z12.11","R52.","M54.89","Z12.31","F41.1","Z76.89"],"date":["2021-07-20","2021-05-07","2021-05-07","2021-01-28","2021-01-28","2020-11-30","2020-11-30","2020-12-17","2021-06-07","2021-08-03","2021-04-29","2021-04-29","2021-04-29","2021-07-06","2021-04-29","2021-04-29","2021-09-08","2021-09-16","2021-09-16"],"priorHcc":["","","","","","","","","",null,"","","",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":[["","00378427693","VALACYCLOVIR ","1GM","6","Select","Select",""],["","29300022701","METRONIDAZOL ","500MG","14","Select","Select",""],["","60505017009","PRAVASTATIN ","40MG","90","Select","Select",""],["","69097084507","CYCLOBENZAPR ","5MG","30","Select","Select",""],["","057237001830","DULOXETINE ","30MG","30","Select","Select",""],["","00378427693","","1GM","6","Select","Select",""],["","00378427693","VALACYCLOVIR","1GM","6","Select","Select",""],["","29300022701","METRONIDAZOL","500MG","14","Select","Select",""],["","60505017009","PRAVASTATIN","40MG","90","Select","Select",""],["","69097084507","CYCLOBENZAPR","5MG","30","Select","Select",""],["","57237001830","DULOXETINE","30MG","30","Select","Select",""],["","65162044110","MECLIZINE","12.5MG","30","Select","Select",""],["","65162044110","MECLIZINE ","TAB 12.5MG","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","",""],["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":""}]}]}