{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BEVERLY   B TUSING","gend":0,"add":"15384 EVERGREEN VALLEY RD","city":"TIMBERVILLE","state":"VA","zip":"22853-9998","dob":"1940-09-06","age":"","mstatus":"","insh":"900040760*01","cliId":"8RG4YY9RD66","pno":"540\/383-1639","cno":"540\/383-1639","email":"","ename":"","eno":"","pphy":"PHYSICIAN, MR PRIMARY CARE MD","ppno":"","pcpadd":"4417 CORPORATION LANE","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23462,"pcpcounty":"","pcpid":"799MR","pcpname":"","plan":"OHP","program":"MEDICARE","lob":"MA-NON DSNP","region":"WESTERN\/ CHARLOTTESVILLE","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":["M65.321","M65.351","M65.341","M65.311","M65.331","M65.322","M65.312","M65.332","M65.342","M65.352","H34.8322","H34.8320","Z09.","D22.5","L81.4","L82.1","L73.8","Z08.","Z85.820","Z87.2","K60.3","E11.9","I10.","L85.3","R53.83","E78.5","E11.8","Z01.810","I44.7","E03.9"],"date":["2021-03-17","2021-03-17","2021-03-17","2021-03-17","2021-03-17","2021-03-17","2021-03-17","2021-03-17","2021-03-17","2021-03-17","2021-06-23","2021-04-14","2021-06-07","2021-06-07","2021-06-07","2021-06-07","2021-06-07","2021-06-07","2021-06-07","2021-06-07","2021-07-12","2021-04-21","2021-04-21","2021-01-07","2021-04-14","2021-04-21","2021-04-14","2021-06-29","2021-06-29","2021-04-21"],"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":[["","000378001805","METOPROL ","25MG","180","Select","Select",""],["","060505258008","ATORVASTATIN ","40MG","90","Select","Select",""],["","065862020299","LOSARTAN ","50MG","90","Select","Select",""],["","053885024510","ONETOUCH ","ULTRA","100","Select","Select",""],["","069238183007","LEVOTHYROXIN ","25MCG","90","Select","Select",""],["","065862056099","PANTOPRAZOLE ","40MG","90","Select","Select",""],["","042858000101","OXYCODONE ","5MG","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":[[["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":""}]}]}