{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ELBERT   J MASON JR","gend":0,"add":"1230 HIGH ROCK TRL","city":"VERNON HILL","state":"VA","zip":"24597-9998","dob":"1941-03-28","age":"","mstatus":"","insh":"900041581*01","cliId":"6K61HN4QD97","pno":"434\/476-1171","cno":"434\/476-1171","email":"","ename":"","eno":"","pphy":"PATEL, BABITA B MD","ppno":"434\/517-5180","pcpadd":"1129 N MAIN ST","pcpcity":"SOUTH BOSTON","pcpstate":"VA","pcpzip":24592,"pcpcounty":"","pcpid":157457,"pcpname":"","plan":"OHP","program":"MEDICARE","lob":"MA-Non DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/517-6179","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K21.9","K22.4","R13.19","R21.","S30.861A","R91.8","R07.9","R07.89","R06.00","I25.10","I10.","E78.2","I25.5","Z20.822","I20.0","K22.2","K31.7","I48.0","H35.3132","R07.2","M25.562","M17.12","G89.29","I25.2"],"date":["2021-03-24","2021-03-24","2021-03-24","2021-06-04","2021-06-04","2021-02-26","2021-02-26","2021-03-08","2021-03-02","2021-07-07","2021-07-23","2021-07-07","2021-07-07","2021-03-22","2021-02-26","2021-03-19","2021-03-19","2021-07-07","2021-03-25","2021-02-26","2021-06-11","2021-07-21","2021-06-11","2021-07-21"],"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":[["","60505008000","SOTALOL ","80MG","90","Select","Select",""],["","00003089421","ELIQUIS ","5MG","-180","Select","Select",""],["","72733590102","PRALUENT ","75MG\/ML","2","Select","Select",""],["","65862056090","PANTOPRAZOLE ","40MG","90","Select","Select",""],["","72511075001","REPATHA ","140MG\/ML","2","Select","Select",""],["","59762330403","NITROGLYCERN ","0.4MG","-25","Select","Select",""],["","00143211250","DOXYCYCL ","100MG","42","Select","Select",""],["","00781261305","AMOXICILLIN ","500MG","21","Select","Select",""],["","60505008000","","80MG","90","Select","Select",""],["","60505008000","SOTALOL","80MG","90","Select","Select",""],["","00003089421","ELIQUIS","5MG","-180","Select","Select",""],["","65862056090","PANTOPRAZOLE","40MG","90","Select","Select",""],["","72733590102","PRALUENT","75MG\/ML","2","Select","Select",""],["","59762330403","NITROGLYCERN","0.4MG","25","Select","Select",""],["","72511075001","REPATHA","140MG\/ML","-2","Select","Select",""],["","00143211205","DOXYCYCL","100MG","42","Select","Select",""],["","53746010901","HYDROCO\/APAP","5-325MG","12","Select","Select",""],["","00781261305","AMOXICILLIN","500MG","21","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":""}]}]}