{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CAROLYN   Y BUNDY","gend":1,"add":"3302 BATTERY ROAD","city":"TAPPAHANNOCK","state":"VA","zip":"22560-9998","dob":"1967-12-31","age":"","mstatus":"","insh":"900041614*01","cliId":"7FK5A26KN97","pno":"804\/443-3691","cno":"804\/443-3691","email":"","ename":"","eno":"","pphy":"JOHNSON, DANIELLE A MD","ppno":"804\/828-8786","pcpadd":"417 N 11TH STREET","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":23298,"pcpcounty":"","pcpid":670982,"pcpname":"","plan":"OHP","program":"MEDICARE","lob":"MA-Non DSNP","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/828-5466","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z12.31","I49.3","I10.","R07.9","F32.9","E78.5","G47.33","G40.909","G40.009","Z79.899","Z45.02"],"date":["2021-07-19","2021-07-07","2021-07-07","2021-07-07","2021-07-07","2021-07-07","2021-07-07","2021-07-07","2021-10-26","2021-10-26","2021-08-09"],"priorHcc":["","",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":[["","00093505898","ATORVASTATIN ","40MG","90","Select","Select",""],["","43547040211","FUROSEMIDE ","40MG","90","Select","Select",""],["","59746021601","SPIRONOLACT ","25MG","90","Select","Select",""],["","00487950125","ALBUTEROL ","0.08%","75","Select","Select",""],["","68645019059","METOPROL ","50MG","270","Select","Select",""],["","68645055554","LISINOPRIL ","40MG","90","Select","Select",""],["","050111032801","HYDRALAZINE ","50MG","270","Select","Select",""],["","068645057054","CITALOPRAM ","20MG","90","Select","Select",""],["","029300011716","TOPIRAMATE ","100MG","360","Select","Select",""],["","000781598701","CARBAMAZEPIN ","200MG ER","360","Select","Select",""],["","43547040211","","40MG","90","Select","Select",""],["","59746021601","SPIRONOLACT","25MG","90","Select","Select",""],["","00093505898","ATORVASTATIN","40MG","90","Select","Select",""],["","68645055554","LISINOPRIL","40MG","90","Select","Select",""],["","00487950125","ALBUTEROL","0.08%","75","Select","Select",""],["","68645019059","METOPROL","50MG","270","Select","Select",""],["","00054429931","FUROSEMIDE","40MG","90","Select","Select",""],["","68645057054","CITALOPRAM","20MG","-90","Select","Select",""],["","29300011716","TOPIRAMATE","100MG","360","Select","Select",""],["","00781598701","CARBAMAZEPIN","200MG ER","360","Select","Select",""],["","31722052101","HYDRALAZINE","50MG","270","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":""}]}]}