{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JOYCE   D BAXLEY","gend":1,"add":"3824 BLACKSTONE ROAD","city":"KENBRIDGE","state":"VA","zip":"23944-9998","dob":"1941-08-07","age":"","mstatus":"","insh":"900040789*01","cliId":"3J63U69MK73","pno":"434\/676-2798","cno":"434\/676-2798","email":"","ename":"","eno":"","pphy":"TURNER, BANKS MD","ppno":"804\/359-1351","pcpadd":"2201 GROVE AVE","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":23220,"pcpcounty":"","pcpid":210285,"pcpname":"","plan":"OHP","program":"MEDICARE","lob":"MA-Non DSNP","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/355-6625","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["C90.00","E03.9","C79.51","E55.9","Z51.11","G62.0","E83.52","I82.402","E83.51","R68.89","R53.83","Z79.01","Z51.12","R60.0","J98.11","R06.00","R07.9","L90.0","Z71.89","Z71.3","R10.84","R10.11","R10.30"],"date":["2021-11-16","2021-11-16","2021-11-16","2021-11-16","2021-11-16","2021-11-16","2021-11-16","2021-11-16","2021-11-16","2021-11-16","2021-11-16","2021-09-14","2021-11-16","2021-08-03","2021-08-03","2021-08-03","2021-08-03","2021-09-10","2021-09-10","2021-09-10","2021-09-10","2021-11-18","2021-10-15"],"priorHcc":[null,null,null,null,null,null,null,null,null,null,null,null,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":[["","59572050121","POMALYST ","1MG","10","Select","Select",""],["","68382009205","CARVEDILOL ","3.125MG","180","Select","Select",""],["","65862018830","ONDANSETRON ","8MG","180","Select","Select",""],["","62332000131","FAMOTIDINE ","20MG","180","Select","Select",""],["","69097017353","IPRATROPIUM\/ ","ALBUTER","180","Select","Select",""],["","68180016013","AZITHROMYCIN ","250MG","6","Select","Select",""],["","00054418425","DEXAMETHASON ","4MG","52","Select","Select",""],["","69238183407","LEVOTHYROXIN ","100MCG","90","Select","Select",""],["","00168016315","CLOBETASOL ","0.05%","30","Select","Select",""],["","63020040002","NINLARO ","4MG","6","Select","Select",""],["","59572041028","REVLIMID ","10MG","21","Select","Select",""],["","72578000105","DOXYCYCL ","100MG","14","Select","Select",""],["","59572050121","","1MG","-10","Select","Select",""],["","59572050121","POMALYST","1MG","-10","Select","Select",""],["","68382009205","CARVEDILOL","3.125MG","180","Select","Select",""],["","65862018830","ONDANSETRON","8MG","-180","Select","Select",""],["","68180016013","AZITHROMYCIN","250MG","6","Select","Select",""],["","00054418425","DEXAMETHASON","4MG","48","Select","Select",""],["","69238183407","LEVOTHYROXIN","100MCG","90","Select","Select",""],["","63020040002","NINLARO","4MG","6","Select","Select",""],["","00168016315","CLOBETASOL","0.05%","30","Select","Select",""],["","65862085999","FAMOTIDINE","20MG","180","Select","Select",""],["","72578000105","DOXYCYCL","100MG","14","Select","Select",""],["","68462029817","CLOTRIM\/BETA","DIPROP","15","Select","Select",""],["","59572041028","REVLIMID","10MG","21","Select","Select",""],["","69097017353","IPRATROPIUM\/","ALBUTER","180","Select","Select",""],["","00378161001","DICYCLOMINE ","CAP 10MG","20","Select","Select",""],["","68462029817","CLOTRIM\/BETA ","CRE DIPROP","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":[[["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":""}]}]}